Intravenous use of prescribed sublingual buprenorphine tablets by drug users receiving maintenance therapy in France

Background: In 1996, sublingual buprenorphine was authorized for prescription in France for maintenance therapy (MT). MT should facilitate the rehabilitation of opioid-dependent drug users and reduce the risks associated with injection. However, misuse and side effects have been reported. Objectives: To assess the frequency of buprenorphine injection in 404 subjects on buprenorphine MT and to determine the factors associated with the injection of buprenorphine. Methods: A cross-sectional survey was used to collect data from subjects on buprenorphine MT seeking treatment from health care networks, specialized structures, a prison and a hostel in three different regions of France (1998–1999). Information was collected by trained interviewers using a structured questionnaire. Results: About half (46.5%) of the subjects on MT (188/404) had ever injected buprenorphine; 67.2% of this subgroup had since used both injected and sublingual buprenorphine. Variables associated with buprenorphine injection were having injected a substance other than buprenorphine (odds ratio (OR): 13.18; 95% CI: 5.36–32.42), cannabis use (OR: 2.34; 95% CI: 1.51–3.63) and having a source of income other than a salary (OR: 1.58; 95% CI: 1.02–2.45) and heroin use (OR: 0.23; 95% CI: 0.09–0.61). Conclusions: To decrease buprenorphine injection, prescribers of buprenorphine should participate in networks with specialized centers, and social and professional rehabilitation programs should be implemented for subjects on buprenorphine MT.