Patterns of Intravenous Buprenorphine–Naloxone Misuse: Psychiatric Morbidity, Risk Behaviours, Diversion, and Serological Findings

Background: Intravenous misuse of buprenorphine–naloxone (BPNX) is a growing concern for patients with opioid use disorder (OUD). However, data on psychiatric comorbidities, patterns of diversion, and the burden of infectious diseases among individuals who inject BPNX in India remain limited. This study aimed to assess the clinical profile, diversion patterns, and seroprevalence among these patients. Methods: Seventy-three patients with a diagnosis of OUD injecting BPNX, were recruited for this study. Sociodemographic and clinical variables, diversion patterns, high-risk behaviors, and overdose history were assessed using a semi-structured proforma. Triple serology testing for HIV, HBV, and HCV was conducted, and relevant statistical analyses were performed. Results: The participants were predominantly young men with a mean age of 25.9 ± 6.05 years. Psychiatric comorbidity was present in 67.1% of participants, and attention-deficit hyperactivity disorder (ADHD) was the most common diagnosis. HCV seropositivity was found in 68.5% and HCV RNA in 52.05%. Most participants used both prescription and diverted BPNX to avoid withdrawal symptoms. High-frequency misuse was significantly linked to longer opioid dependence and needle sharing. Conclusions: The misuse of intravenous BPNX was linked to significant psychiatric comorbidity, unsafe injection practices, and a high burden of infectious diseases. The persistence of diversion despite the BPNX combination formulation suggests the current naloxone dose ratio may not be effective as a deterrent. Urgent integrated addiction, psychiatric, and harm-reduction services are needed.