Article Commentary: Demystifying Buprenorphine Misuse: Has Fear of Diversion Gotten in the Way of Addressing the Opioid Crisis?

Abstract

Buprenorphine is considered one of the most effective treatments for opioid use disorder and significantly reduces risk of overdose death. However, concerns about its diversion and misuse have often taken center stage in public discourse and in the design of practices and policies regarding its use. This has been to the detriment of many vulnerable patient populations, especially those involved in the criminal justice system. Policies that restrict access to buprenorphine in criminal justice and other settings due to concerns of diversion do not accurately reflect the relative risks and safety profile associated with it, creating unnecessary barriers that drive an illicit market of this much-needed medication. Although proper regulation of all controlled medications should be a priority, in most instances the benefits of buprenorphine highly outweigh its risks. In the midst of a national crisis, efforts should be focused on expanding, and not restricting, access to this life-saving treatment.

Opioid agonist treatment and fatal overdose risk in a state‐wide US population receiving opioid use disorder services

“…While treatment discontinuation is partly driven by the relapsing nature of OUD , retention could be improved through stronger promotion of long‐term maintenance as the standard of care and by eliminating programmatic, logistical and financial barriers. For example, addressing medication stigma and removing burdensome treatment requirements, such as daily attendance or zero tolerance , may encourage better and longer engagement . The risk that may be incurred immediately after treatment discontinuation also highlights the critical need to couple care with overdose education and harm‐reduction modalities, such as naloxone training and distribution .…”

Expanding low-threshold buprenorphine to justice-involved individuals through mobile treatment: Addressing a critical care gap

“…Although medication treatment in jails and prisons is receiving greater attention (Fiscella, Wakeman, & Beletsky, 2018), implementing such changes across the country will likely be a slow moving process both politically and logistically. Many institutions continue to resist buprenorphine, specifically, due to concerns about diversion (Doemberg et al, 2019; Wish et al, 2012). Even when the institutions want to participate in providing medication treatment, it is difficult to do so effectively for detainees who are pretrial due to the rapid turnover and lack of time for discharge planning or for providing stability in treatment over the critical first few weeks.…”

“…This training allowed correctional staff to share their insights about challenges they face managing behavioral health conditions in the jail and learn about the evidence behind pharmacotherapy treatment and the impact on health and criminal justice outcomes. This training component was essential to build a relationship for communication, especially given that many criminal justice staff had reservations and misconceptions about pharmacotherapy for OUD (Doernberg, Krawczyk, Agus, & Fingerhood, 2019; Friedmann et al, 2012; Matusow et al, 2013).…”

Opioid agonist treatment is highly protective against overdose death among a U.S. statewide population of justice-involved adults

“…Several reasons have been suggested as contributing to the hesitancy of criminal justice entities to refer to OAT. These include misconceptions about the effectiveness of medication treatments, concerns about illicit diversion of medications, as well as lack of formal linkages with OAT providers (36)(37)(38)(39). Addressing these barriers must therefore be an integral part of efforts to expand the use of medications for justice-involved persons.…”