Buprenorphine prescription patterns at a tertiary care hospital in northern India: A retrospective chart review

Background: Opioid use disorder (OUD) prevalence is increasing in our country and heroin is the most widely used opioid in India, with an estimated 8.5 lakh People Who Inject Drugs (PWID). Despite the evidence supporting the benefits of MOUD, it remains underused, and access to different MOUD varies widely. Methodology: A retrospective chart review was done for past 3 years of both outpatient and inpatient patients of Opioid dependence syndrome (based on ICD 10 criteria) visiting the outpatient services and inpatient setting of department of Psychiatry at MMIMSR, Ambala, India. The details comprised of sociodemographic profile of the patient, type of opioid dependence and history of Injection Drug Use. The treatment details such as type of medication, planned for detoxification or long-term treatment and retention into treatment were evaluated. Institutional ethical clearance was taken for the study.Results: The mean age of the subjects was 24.6 +/- 3.5years for the outpatients and 26.2 +/- 2.4 years for inpatient. Most of the patients presenting for the treatment comprised of heroin dependence (n= 332, 76.3%) in outpatients and (n= 115, 85.2%) followed by opium and pharmaceutical opioids. Injection drug use was seen in 11.5% (n=50) of outpatients and 15.7% (n=21) of inpatients. We further studied use of Tab. Buprenorphine in managing heroin dependence. Overall, 53% (n=176) outpatients and 73.9% (85) inpatients received Tab. Buprenorphine- Naloxone combination (2mg) over past 3 years. However, most of the subjects were on detoxification regimen and very few were given long term agonist-based treatment. There was poor retention of patients in treatment.Discussion: Our study highlighted the use of buprenorphine primarily for detoxification regimes. It could be attributed to multiple factors both for healthcare providers and patients. It could range from strict regulation of MOUD, stigma associated with the medication itself, financial constraints and lack of training in management of addictive disorders.