Buprenorphine Use and Risk of Abuse and Diversion

Abstract

Buprenorphine in Opioid Maintenance Treatment: A Brief UpdateBuprenorphine is an established first-line medication for the treatment of opioid dependence (see APA guidelines [24] AbstractOpioid maintenance therapy with methadone or buprenorphine is a well-established first-line treatment for opioid dependence. However, risk of diversion and drug-related mortality are critical issues during maintenance therapy. These issues are discussed controversially in both the scientific and public arenas and are a matter of concern also among medical authorities. In addition to a formulation containing buprenorphine alone, a combination formulation with buprenorphine and naloxone in a 4:1 ratio is available. The combination formulation was developed with the aim to prevent intravenous use or diversion. This critical review summarizes data on the risk of abuse and diversion of buprenorphine.

Therapy without a prescription: buprenorphine/naloxone diversion and the therapeutic assemblage in Taiwan

“…, Mendelson et al . , Soyka ). Thus, most individuals who use this combination quickly learn how to apply the medication at the right time and through the right route.…”

“…It is minimally absorbed when given sublingually but taken up quickly when given intravenously. Therefore, if one dissolves a sublingual tablet in water and injects it into a vein when heroin effects are present, naloxone in the tablet will immediately antagonise the effects and precipitate extremely unpleasant withdrawal reactions, such as runny nose, joint pain, and other flu-like symptoms (Lavonas et al 2014, Mendelson et al 1999, Soyka 2014. Thus, most individuals who use this combination quickly learn how to apply the medication at the right time and through the right route.…”

Sykepleiere kan forebygge lekkasje av LAR-legemidler

“…Den vanligste misbruksmåten for buprenorfin er at tablett eller film løses opp i vann og injiseres, og buprenorfin gir da en morfinliknende rus. Buprenorfin kan også sniffes, inhaleres/røykes eller tas sublingvalt (under tungen) for å oppnå ruseffekt (4,8). Metadon drikkes eller injiseres.…”

“…Substitusjonsbehandling med langtidsvirkende opioider, på norsk kalt legemiddelassistert rehabilitering (LAR), reduserer dødelighet og sykelighet hos pasienter med opioidavhengighet (1, 2). Samtidig er lekkasje av substitusjonslegemidlene til det illegale narkotikamarkedet en utfordring i mange land (3)(4)(5)(6)(7)(8). Lekkasje er ofte definert som å selge eller gi bort substitusjonslegemidlene til personer legemidlene ikke er ment for.…”

Prior Experience with Non-Prescribed Buprenorphine: Role in Treatment Entry and Retention

“…However, the increase in availability of buprenorphine treatment has been accompanied by increased buprenorphine diversion (Bazazi, Yokell, Fu, Rich, & Zaller, 2011; Genberg et al, 2013; Lee, Klein-Schwartz, Welsh, & Doyon, 2013; Schuman-Olivier et al, 2010; Soyka, 2014; Yokell, Zaller, Green, & Rich, 2011), and related medical problems associated with its misuse (Auriacombe et al, 2004; Cicero, Surratt, & Inciardi, 2007; Daniulaityte, Falck, & Carlson, 2012; Ho, Ho, & Mak, 2009). Prior research identified that many opioid-dependent individuals who use diverted or “street buprenorphine” do so primarily for the purpose of self-medicating their withdrawal symptoms, and not to “get high” (Bazazi et al, 2011; Genberg et al, 2013; Hakansson, Medvedeo, Andersson, & Berglund, 2007; Mitchell et al, 2009; Monte, Mandell, Wilford, Tennyson, & Boyer, 2009; Schuman-Olivier et al, 2010).…”