Scope of, Motivations for, and Outcomes Associated with Buprenorphine Diversion in the United States: A Scoping Review

Rubel, Stephanie K.; Eisenstat, Matthew; Wolff, Jessica; Calevski, Michael; Mital, Sasha

doi:10.1080/10826084.2023.2177972

Cited by 8 publications

(5 citation statements)

References 78 publications

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“…using medication for anything other than its intended purpose) of opioid agonists continues to be under debate. There is little evidence to support that diverted buprenorphine is primarily used for euphoric effects – several U.S. found that people with OUD who misuse their prescribed buprenorphine reported motivations ranging from self-treatment, pain-relief, to withdrawal symptoms management ( 29 , 30 ).…”

Section: Discussionmentioning

confidence: 99%

Perspectives of substance use disorder counselors on the benefits and drawbacks of medications for opioid use disorder

Cardamone,

Stewart,

Kampman

et al. 2024

Preprint

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Background: Medications for opioid use disorder (MOUD) are among the best tools we have to combat the opioid epidemic. Yet, use of MOUD among people with opioid use disorder (OUD) remains low. Interventions to increase MOUD access in the United States have largely focused on improving organizational capacity and addressing funding barriers, yet stigma toward MOUD may inhibit uptake even where MOUD is readily available. Substance use disorder (SUD) treatment counselors likely have considerable influence on a client’s choice to initiate and adhere to MOUD, but beliefs that counselors convey about MOUD in interaction with clients are understudied. The current study explores what advantages and disadvantages that SUD treatment counselors communicate about buprenorphine, methadone, and naltrexone. Methods: From June to December 2021, we surveyed counselors from publicly-funded SUD treatment agencies under a municipality-wide mandate to offer MOUD to all clients with OUD. Counselors were asked to describe, in a free-response format, the most important advantages and disadvantages to communicate to their clients about taking buprenorphine, methadone, and naltrexone. Counselor responses were coded for one or more advantage and disadvantage. Results: A total of 271 SUD counselors from 29 agencies completed the survey, generating 1,995 advantages and disadvantages across three types of MOUD. The most frequently reported advantage across all three types of MOUD was their ability to reduce cravings and illicit drug use. The most frequently reported disadvantage related to the potential for some types of MOUD to develop long-term medication dependence. Conclusions: As the availability and variety of MOUD treatment options continue to expand, it is important that SUD counselors are equipped with evidence-based recommendations for OUD care. We identified misalignments with the MOUD-prescribing evidence base and stigmatizing language toward MOUD within counselors’ responses, highlighting the potential to refine training materials for MOUD and mitigate stigmatizing beliefs.

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Section: Discussionmentioning

confidence: 99%

Perspectives of substance use disorder counselors on the benefits and drawbacks of medications for opioid use disorder

Cardamone,

Stewart,

Kampman

et al. 2024

Preprint

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“…The reports of buprenorphine misuse in France were primarily among individuals with OUD and a history of injection drug use rather than individuals initiating opioid use [ 54 ]. There is little evidence to suggest the uptake of diverted buprenorphine by opioid-naive individuals is occurring within the USA [ 11 , 13 ]. Accordingly, our main analysis did not simulate this pathway to opioid use.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, diverted buprenorphine can be misused for euphoria and poses a risk to pediatric populations if accidentally ingested [ 9 , 10 ]. However, studies suggest that most diverted buprenorphine in the USA is used by people who already have an opioid dependence to reduce their health risks from opioid use, stave off withdrawal, or bridge gaps in treatment, rather than for euphoria [ 11 – 13 ]. Furthermore, self-treatment with diverted buprenorphine will lower overdose risk if individuals use diverted buprenorphine instead of heroin and fentanyl [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Examining buprenorphine diversion through a harm reduction lens: an agent-based modeling study

Adams,

Duprey,

Khan

et al. 2023

Harm Reduct J

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Background Recent policies have lessened restrictions around prescribing buprenorphine-naloxone (buprenorphine) for the treatment of opioid use disorder (OUD). The primary concern expressed by critics of these policies is the potential for buprenorphine diversion. However, the population-level effects of increased buprenorphine diversion are unclear. If replacing the use of heroin or fentanyl, use of diverted buprenorphine could be protective. Methods Our study aim was to estimate the impact of buprenorphine diversion on opioid overdose using an agent-based model calibrated to North Carolina. We simulated the progression of opioid misuse and opioid-related outcomes over a 5-year period. Our status quo scenario assumed that 50% of those prescribed buprenorphine diverted at least one dose per week to other individuals with OUD and 10% of individuals with OUD used diverted buprenorphine at least once per week. A controlled prescription only scenario assumed that no buprenorphine would be diverted, while an increased diversion scenario assumed that 95% of those prescribed buprenorphine diverted and 50% of individuals with OUD used diverted buprenorphine. We assumed that use of diverted buprenorphine replaced the use of other opioids for that day. Sensitivity analyses increased the risk of overdose when using diverted buprenorphine, increased the frequency of diverted buprenorphine use, and simulated use of diverted buprenorphine by opioid-naïve individuals. Scenarios were compared on opioid overdose-related outcomes over the 5-year period. Results Our status quo scenario predicted 10,658 (credible interval [CI]: 9699–11,679) fatal opioid overdoses. A scenario simulating controlled prescription only of buprenorphine (i.e., no diversion) resulted in 10,741 (9895–11,650) fatal opioid overdoses versus 10,301 (9439–11,244) within a scenario simulating increased diversion. Compared to the status quo, the controlled prescription only scenario resulted in a similar number of fatal overdoses, while the scenario with increased diversion of buprenorphine resulted in 357 (3.35%) fewer fatal overdoses. Even when increasing overdose risk while using diverted buprenorphine and incorporating use by opioid naïve individuals, increased diversion did not increase overdoses compared to a scenario with no buprenorphine diversion. Conclusions A similar number of opioid overdoses occurred under modeling conditions with increased rates of buprenorphine diversion among persons with OUD, with non-statistical trends toward lower opioid overdoses. These results support existing calls for low- to no-barrier access to buprenorphine for persons with OUD.

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mentioning

confidence: 99%

“…Unfortunately, despite these benefits, the DEA and the Department of Health and Human Services recently proposed to reinstate the requirement for an in-person examination for telehealth patients who remain on buprenorphine for longer than 30 days. 9 If the proposed amendments are codified into law, buprenorphine access will decrease, and people living in rural areas and underserved communities will likely bear the burden of this proposed change. The change would magnify the barriers identified in the study by Sue et al, 5 as community treatment centers already face limited treatment capacity and difficulties addressing sociostructural marginalization.…”

mentioning

confidence: 99%

Identifying Barriers to OUD Treatment Linkage From the Emergency Department to the Community

2023

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Associated with illicitly manufactured fentanyl and its analogues, the current opioid overdose epidemic is the largest recorded in US history. 1 Emergency departments (ED) are essential sites of care for people with opioid use disorder (OUD) and present an opportunity to initiate medications for OUD, including buprenorphine. ED-initiated buprenorphine combined with a follow-up appointment and buprenorphine prescription increases OUD treatment engagement and decreases selfreported illicit opioid use. 2 A recent study by Hawk et al 3 of ED practitioners identified a lack of training or experience with buprenorphine, concerns about availability of outpatient follow-up, and competing needs and priorities for ED resources as barriers to ED-initiated buprenorphine. However, ED practitioners also reported a willingness to initiate buprenorphine with education and training and with availability of local protocols to initiate buprenorphine and pathways to link patients to ongoing OUD care. 3 Addressing and reducing these barriers is imperative to improve ED-initiated buprenorphine and OUD treatment referral. Although ED-initiated buprenorphine is the first step to support patients experiencing opioid withdrawal and to treat OUD, ongoing OUD treatment engagement is necessary to reduce overdose mortality. 4 Thus, building referral pathways between local ED and community OUD treatment practitioners is crucial to ensure that people initiated on buprenorphine in the ED can continue to receive buprenorphine to support their recovery.

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Scope of, Motivations for, and Outcomes Associated with Buprenorphine Diversion in the United States: A Scoping Review

Cited by 8 publications

References 78 publications

Perspectives of substance use disorder counselors on the benefits and drawbacks of medications for opioid use disorder

Perspectives of substance use disorder counselors on the benefits and drawbacks of medications for opioid use disorder

Examining buprenorphine diversion through a harm reduction lens: an agent-based modeling study

Identifying Barriers to OUD Treatment Linkage From the Emergency Department to the Community

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