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Pattern of buprenorphine abuse among opioid abusers in Nepal

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      Background:Although buprenorphine abusers are a common clinical entity, literature on them is rare in Nepal.Aim:To assess whether injectable opioid abusers are any different a subgroup vis-a-vis brown sugar abusers in relation to their demographic and clinical profiles.Materials and Methods:Seventy-six opioid abusers, who were admitted over a period of one year, in our de-addiction center, were included in the present study. They were divided into two groups based on the history of the presence or absence of buprenorphine injection abuse in them. The demographic and clinical profiles of these two groups were studied and compared.Results:The most characteristic opioid abuse pattern was the abuse of brown sugar through inhalation (chasing). A total of 32 (42.1%) among them had a history of injectable drug abuse (IDU). Most characteristic buprenorphine abuse pattern seen was an evolution from injectable buprenorphine to triple injection to brown sugar abuse (Reverse Transition). Injection buprenorphine abusers, who attended our clinic, were older in age and had a history of a longer duration of abuse than their counterparts who abused opioid drugs through the inhalational route only. Their lifetime diagnosis revealed a polysubstance abuse pattern. They were more unstable, impulsive, and disorganized in their behavior pattern, suggestive of the presence of inadequate personality traits. There were high instances of injection-related side effects in the form of the presence of thrombophlebitis, HIV positivity, and clinical AIDS in them.Conclusion:Findings of the current research indicate the presence of a subgroup of patient population among opioid abusers with a history of injectable buprenorphine abuse, with characteristic personality traits, pattern of drug abuse, and associated physical complications resulting from it.

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      Transitions in patterns of heroin administration: a study of heroin chasers and heroin injectors.

      A community sample of 408 heroin users was interviewed about changes in their predominant route of heroin administration. Clear preferences for specific routes of drug administration were evident. Two predominant routes of administration were found: injection (54%) and 'chasing the dragon' (44%). More than a third of the sample had changed their predominant route of administration (a 'transition'). Most commonly, only one transition was reported, from chasing to injecting. However, transition to injection was not inevitable: the majority of 'chasers' had never moved to regular injecting despite often using at high doses for many years. Modelling suggests that many chasers give up heroin without moving to injecting. The results indicate, however, a continuing risk of switching from chasing to injecting for those who continued to use. Women were less likely to move from chasing to injecting. Some heroin users had made the transition from injection to chasing; 28 (16%) of the current chasers had previously been regular heroin injectors. This change in route is less well-known and to our knowledge has not been previously investigated. Multiple transitions in route were uncommon; predominant route of administration, once established appears robust. Harm reduction interventions directed towards changing the risk behaviours of heroin users should take account of the different routes of current administration and the potential for future transitions within continued drug use.
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          Buprenorphine abuse among opiate addicts.


            Author and article information

            Department of Psychiatry, Universal College of Medical Sciences, Bhairahawa, Nepal
            Author notes
            Address for correspondence: Dr. Tapas Kumar Aich Department of Psychiatry, Universal College of Medical Sciences, Bhairahawa, Nepal E-mail: tapas_dr@ , aichtapas@
            Indian J Psychiatry
            Indian Journal of Psychiatry
            Medknow Publications (India )
            Jul-Sep 2010
            : 52
            : 3
            : 250-253
            © Indian Journal of Psychiatry

            This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Original Article

            Clinical Psychology & Psychiatry

            opioid abuse, buprenorphine abuse, idu, nepal


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