Abstract：
Background: Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. Methods: 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. Findings: 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants\' reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Conclusions: Patients\' initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes.
摘要：
背景：阿片类药物使用障碍（OUD）治疗期间的非处方物质使用（NPSU）是一种公认的现象。使用非处方物质与停止治疗有关，并且在治疗的前几周内可能发生脱落，在从治疗中获益之前。治疗的最新进展包括长效，缓释储库丁丙诺啡注射液。本文重点介绍了丁丙诺啡储库治疗的第一个月的NPSU，解决它发生的频率，使用的物质,和使用的原因。方法：作为纵向定性研究的一部分，对26名开始使用丁丙诺啡的患者进行了70次半结构化访谈（在三个时间点进行）。分析优先考虑内容和框架分析。结果：17/26参与者在治疗的第一个月中的不同时间自我报告NPSU。NPSU通常涉及海洛因，可卡因和一些使用苯二氮卓类药物和/或大麻。参与者使用海洛因的原因与他们对阿片类药物戒断症状的主观描述有关，疼痛的管理，和实验（测试丁丙诺啡的阻滞作用）。海洛因的使用频率通常是偶发的，而不是持续的。参与者将可卡因的使用与兴奋剂渴望和社交联系联系起来，并认为他们使用这种物质很难管理。结论：定性研究中很少检查患者最初接受OUD治疗的情况。这项研究强调了接受新形式治疗的患者中的NPSU仍然是一个挑战。因此，关于治疗目标和NPSU的共同决策(提供者和患者之间)应是实施丁丙诺啡储库治疗方案的核心.
