INTRODUCTION The opioid overdose crisis in the United States has prompted an expansion of treatment services, including pharmacotherapy with buprenorphine. However, many people who use illicit opioids (PWUIO) self-treat their opioid-use disorder (OUD) with non-prescribed buprenorphine (NPB) in lieu of attending formal treatment. The present study aims to qualitatively understand motivations of people who are self-treating their OUD with NPB. METHODS Qualitative study designed to supplement and contextualize quantitative findings from natural history study of buprenorphine diversion, self-treatment, and use of substance use disorder treatment services. Interviews were audio-recorded, transcribed, systematically coded and analyzed via Iterative Categorization. STUDY SETTING The Dayton, Ohio metropolitan area in the midwestern United States; a site previously characterized as high impact in the national opioid overdose crisis. PARTICIPANTS Sixty-five individuals (35 men and 30 women) who met the DSM-5 criteria for OUD (moderate or severe) and had used NPB at least one time in the six months prior to their intake interview. RESULTS Participants described four key motivators for self-treating with NPB: perceived demands of formal treatment, the desire to utilize non-prescribed buprenorphine in combination with a geographic relocation, to self-initiate treatment while preparing for formal services, and to bolster a sense of self-determination and agency in their recovery trajectory. CONCLUSIONS Use of NPB is a recognized self-treatment modality among PWUIO, with some PWUIO transitioning into sustained recovery episodes or enrollment in formal treatment. Understanding the motivations for opting out of treatment is crucial for improving forms of care for people with OUD.

中文翻译：

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用我自己的话说：非处方丁丙诺啡的自我治疗阿片类药物使用障碍的动机。

引言在美国，阿片类药物过量的危机促使治疗服务的扩大，包括丁丙诺啡的药物治疗。但是，许多使用非法阿片类药物（PWUIO）的人会使用非处方丁丙诺啡（NPB）自行治疗其阿片类药物使用障碍（OUD）来代替参加正式治疗。本研究旨在定性地了解使用NPB对OUD进行自我治疗的人们的动机。方法定性研究旨在补充丁丙诺啡转移，自我治疗和使用药物滥用症治疗服务的自然史研究中的定量发现，并将其结合起来。通过迭代分类对访谈进行录音，转录，系统编码和分析。研究背景位于美国中西部的俄亥俄州代顿市区。该地区以前曾在全国阿片类药物过量危机中具有很高的影响力。参与者有65名个体（35名男性和30名女性）符合DSM-5的OUD标准（中度或重度），并且在入学面谈之前的六个月中至少使用过NPB一次。结果参与者描述了NPB自我治疗的四个主要动机：对正规治疗的感知需求，利用非处方丁丙诺啡与地理迁移相结合的意愿，在准备正规服务时进行自我治疗以及增强感觉自我决定和代理在恢复轨迹中的作用。结论NPW的使用是PWUIO中一种公认的自我治疗方式，一些PWUIO转变为持续性恢复发作或接受正规治疗。