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Case series of buprenorphine injectors in Kuala Lumpur, Malaysia
R Douglas Bruce1, Sumathi Govindasamy, Laurie Sylla
1AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut 06510-2283, USA. robert.bruce@yale.edu
Abstract:
Diversion of buprenorphine has been described in settings where it is legally prescribed and has become an increasing concern in Malaysia; it resulted in banning of buprenorphine in Singapore where unsubstantiated case reports suggested that buprenorphine injection was associated with particularly poor outcomes. We therefore conducted a case series of qualitative interviews with buprenorphine injectors in Kuala Lumpur, Malaysia to examine further the issues surrounding buprenorphine injection as well as the abuse of midazolam in combination with buprenorphine. Interviews with 19 men do not suggest significant adverse health consequences from buprenorphine injection alone and injectors have adapted diverted buprenorphine as a treatment modality. A subset of these injectors, however, combined buprenorphine and midazolam for euphoric effects with resultant symptoms of a possible pharmacological interaction. Prospective cohort studies, rather than hospital-derived samples, are needed to better understand the safety of buprenorphine injection.
Insights
Diversion of buprenorphine is a concern, but injection alone showed no significant adverse effects in Malaysian men. However, combining buprenorphine with midazolam may cause harmful interactions.
Area of Science:
- Addiction Medicine
- Pharmacology
- Qualitative Research
Background:
- Diversion of buprenorphine is a growing issue, particularly in Malaysia.
- Concerns over buprenorphine injection safety led to its ban in Singapore based on limited evidence.
- This study investigates buprenorphine injection practices and co-use with midazolam in Kuala Lumpur.
Observation:
- Qualitative interviews were conducted with 19 men who inject buprenorphine.
- Participants reported adapting diverted buprenorphine as a self-treatment method.
- A subset of injectors combined buprenorphine with midazolam for recreational purposes.
Findings:
- Buprenorphine injection, when used alone, did not appear to cause significant adverse health consequences in this cohort.
- Combining buprenorphine with midazolam was associated with symptoms suggesting a potential pharmacological interaction.
- Diverted buprenorphine is being utilized as an alternative treatment modality by some individuals.
Implications:
- Further research, specifically prospective cohort studies, is necessary to accurately assess the safety profile of buprenorphine injection.
- Understanding the dynamics of drug diversion and co-use is crucial for public health interventions.
- The findings challenge previous assumptions about the inherent dangers of buprenorphine injection when used in isolation.
