A review of buprenorphine diversion and misuse: The current evidence base and experiences from around the world

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198 Scopus citations

Abstract

Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy has rapidly expanded in the United States and abroad, and, with this increase in medication availability, there have been increasing concerns about its diversion, misuse, and related harms. This narrative review defines the behaviors of diversion and misuse, examines how the pharmacology of buprenorphine alone and in combination with naloxone influence its abuse liability, and describes the epidemiological data on buprenorphine diversion and intravenous misuse, risk factors for its intravenous misuse, and the unintended consequences of misuse and diversion. Physician practices to prevent, screen for, and therapeutically respond to these behaviors, which are a form of medication nonadherence, are discussed, and gaps in knowledge are identified. Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy experiences from other countries that have varied health care systems, public policies, and access to addiction treatment are shared to make clear that diversion and misuse occur across the world in various contexts, for many different reasons, and are not limited to buprenorphine. Comparisons are made with other opioids with known abuse liability and medications with no known abuse. The objective was to facilitate understanding of diversion and misuse so that all factors influencing their expression (patient and provider characteristics and public policy) can be appreciated within a framework that also recognizes the benefits of addiction treatment.With this comprehensive perspective, further carefulwork can help determine howto minimize these behaviors without eroding the current benefits realized through improved addiction treatment access and expansion.

Original languageEnglish
Pages (from-to)315-326
Number of pages12
JournalJournal of Addiction Medicine
Volume8
Issue number5
DOIs
StatePublished - Sep 1 2014

Bibliographical note

Publisher Copyright:
Copyright © 2014 American Society of Addiction Medicine.

Funding

FundersFunder number
National Institute on Drug AbuseR01DA033932
National Institute on Drug AbuseR01DA016718

    Keywords

    • Behavioral pharmacology
    • Buprenorphine
    • Diversion
    • Epidemiology
    • Misuse
    • Treatment

    ASJC Scopus subject areas

    • Psychiatry and Mental health
    • Pharmacology (medical)

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