"They're making it so hard for people to get help:" Motivations for non-prescribed buprenorphine use in a time of treatment expansion.

BACKGROUND: Buprenorphine maintenance therapy (BMT) has been widely recognized as one of the most effective treatments for opioid use disorders (OUD). In the midst of the U.S. opioid overdose crisis, local, state, and federal authorities have attempted to increase the availability of BMT, yet few individuals meeting the criteria for OUD utilize BMT. Moreover, recent research suggests that a significant proportion of individuals who use opioids seek out buprenorphine on the illicit market to self-govern and manage withdrawal sickness. METHODS: This paper presents data from a geographic sub-sample within a multi-site study of buprenorphine diversion in Pennsylvania. We endeavor to bolster a slim qualitative literature on the use of non-prescribed buprenorphine through in-depth interviews with 20 individuals who reported buying or receiving buprenorphine outside of medically-sanctioned contexts. Interviews characterized participants' reasons for both using non-prescribed buprenorphine and eschewing formal treatment, in a state (Pennsylvania) afflicted with high rates of heroin use and overdose deaths. Transcripts were initially coded for broad interview topics, while latent themes relating to buprenorphine diversion and extra-medical use also emerged. RESULTS: Analyses revealed complex motivations underlying participants' extra-medical use of buprenorphine. Where some expressed a desire for treatment autonomy and treatment medications that could not be achieved or obtained within BMT, individuals also indicated a persistent lack of treatment availability and access due to diverse barriers. CONCLUSION: This study shows how issues related to availability, accessibility, and acceptability many explain low rates of BMT utilization, even within a place and time defined by medication-assisted treatment expansion. Beyond offering broad rhetorical and financial support for MAT, our findings suggest that governmental actors should continue to pursue policies that expand the spatial distribution of BMT. It also underscores the need to look beyond current models of buprenorphine maintenance and to consider modes of buprenorphine delivery beyond long-term maintenance.

Support for Restorative Justice in a Sample of U.S. University Students.

Theories of restorative justice suggest that the practice works best when offenders are enmeshed in multiple interdependencies or attachments to others and belong to a culture that facilitates communitarianism instead of individualism. Restorative justice principles and practices are thus believed to be incongruent with the individualistic culture and legal system of the United States, especially compared with that of nations like Australia and Japan. Using a nonprobability convenience sample of students enrolled in a large public university in the United States, our study examines attitudes toward restorative justice as a fair and just process for reintegrating offenders and meeting the needs of victims. Results indicate that our sample holds less punitive attitudes than citizens in either Australia or Japan. Our findings are discussed in light of recent policy shifts in the United States that suggest a concerted move toward decarceration following the 2008 recession.