A new analysis from Baltimore illustrates persistent gaps in opioid addiction care, finding that prescribed medication alone does not eliminate the need for extra-medical sourcing.
Investigators tracked 641 adults in the ALIVE cohort who inject drugs and were engaged in formal treatment. Across 1,325 visits logged through late 2024, extra-medical use of methadone or buprenorphine surfaced in 10% of encounters. At the individual level, 18% of participants reported such use at least once.
Severe clinical vulnerability drove the behavior. Injection drug use increased the odds nearly sevenfold, while polysubstance use raised it sixfold. Withdrawal sickness, depression, homelessness, and recent incarceration were also strongly associated.
The structure of formal care influenced outcomes differently by medication. For methadone patients, longer treatment duration significantly reduced the odds of external sourcing. Conversely, higher doses of buprenorphine correlated with increased extra-medical use.
Researchers suggest that extra-medical use often serves as a strategy to manage symptoms during gaps in care, insufficient dosing, or enrollment disruptions.