Twelve-year trend in treatment seeking for buprenorphine abuse in Finland

Uosukainen, Hanna; Kauhanen, Jussi; Voutilainen, Sari; Föhr, Jaana; Paasolainen, Mika; Tiihonen, Jari; Laitinen, Kirsti; Onyeka, Ifeoma N.; Bell, J. Simon

doi:10.1016/j.drugalcdep.2012.07.002

Cited by 26 publications

(22 citation statements)

References 53 publications

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“…Finland developed significant problems with increasing numbers of daily intravenous buprenorphine users in the late 1990's when heroin availability was declining due to decreased supply from Afghanistan (NBI, 2003; Uosukainen et al, 2013c). Finnish authorities reported that the primary source of misused BUP was from outside its borders (Forsell et al, 2010).…”

Section: Epidemiology Of Buprenorphine Diversion and Misusementioning

confidence: 99%

“…Finnish authorities reported that the primary source of misused BUP was from outside its borders (Forsell et al, 2010). By 2001, BUP replaced heroin as the most commonly abused opioid among persons seeking addiction treatment (Uosukainen et al, 2013c). Averaged over the 11-year period from 1998-2008, 16% of those surveyed who were seeking any type of substance abuse treatment identified buprenorphine as their primary drug of abuse; 80% were using it intravenously and most also were misusing other prescription-type medications (Uosukainen et al, 2013c).…”

Section: Epidemiology Of Buprenorphine Diversion and Misusementioning

confidence: 99%

“…By 2001, BUP replaced heroin as the most commonly abused opioid among persons seeking addiction treatment (Uosukainen et al, 2013c). Averaged over the 11-year period from 1998-2008, 16% of those surveyed who were seeking any type of substance abuse treatment identified buprenorphine as their primary drug of abuse; 80% were using it intravenously and most also were misusing other prescription-type medications (Uosukainen et al, 2013c). Treatment for people who were abusing buprenorphine was primarily with lofexidine and withdrawal protocols, and mortality rates were high, similar to those with primary abuse of heroin (Uosukainen et al, 2013b).…”

Section: Epidemiology Of Buprenorphine Diversion and Misusementioning

confidence: 99%

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A Review of Buprenorphine Diversion and Misuse

Lofwall

Walsh

2014

Journal of Addiction Medicine

208

109

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Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy (OBOT) 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 non-adherence, are discussed and gaps in knowledge are identified. OBOT experiences from other countries that have varied health care systems, public policies, and access to addiction treatment are shared in order 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 as well as medications with no known abuse. The objective is 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 careful work can help determine how to minimize these behaviors without eroding the current benefits realized through improved addiction treatment access and expansion.

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Section: Epidemiology Of Buprenorphine Diversion and Misusementioning

confidence: 99%

Section: Epidemiology Of Buprenorphine Diversion and Misusementioning

confidence: 99%

Section: Epidemiology Of Buprenorphine Diversion and Misusementioning

confidence: 99%

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A Review of Buprenorphine Diversion and Misuse

Lofwall

Walsh

2014

Journal of Addiction Medicine

208

109

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“…Buprenorphine clients in Finland resembled “street users” in other countries in terms of socioeconomic status. 47 In another study, 25% of all lethal intoxications in people who abused drugs in Finland in 2007 involved buprenorphine. 52 Lethal buprenorphine intoxications were typically associated with concurrent use of benzodiazepines and alcohol (82% and 58% of buprenorphine poisonings in Finland from 2000 to 2008, respectively).…”

Section: Misuse Abuse and Diversion Of Buprenorphinementioning

confidence: 99%

“…A 12-year follow-up study in Finland demonstrated that the annual proportion of clients seeking treatment for buprenorphine abuse increased from 3.0% in 1998 to 38.4% in 2008. 47 Daily abuse (73.8%) and intravenous administration (80.6%) were common. Buprenorphine clients in Finland resembled “street users” in other countries in terms of socioeconomic status.…”

Section: Misuse Abuse and Diversion Of Buprenorphinementioning

confidence: 99%

Buprenorphine Prescribing: To Expand or Not to Expand

Shorter

Kosten

2016

Journal of Psychiatric Practice

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As a result of the prescription opioid epidemic in the United States, there has been an increasing need for effective treatment interventions, both pharmacologic and non-pharmacologic. Buprenorphine has emerged as a critical component of the treatment of opioid use disorder, yet its adoption has not been without some concerns. This article first reviews the pharmacology, clinical use, and US legislative action related to buprenorphine, followed by a discussion of the misuse and diversion of buprenorphine in the United States as well as internationally. We then explore the impact of buprenorphine abuse as well as discussing strategies for its reduction, including changes in policy, prescription and pharmacy monitoring, and continuing medical education for guiding and improving clinical practice.

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Substance Abuse: Opioid‐Related Disorders

Woody

Fudala

2015

Psychiatry

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Twelve-year trend in treatment seeking for buprenorphine abuse in Finland

Cited by 26 publications

References 53 publications

A Review of Buprenorphine Diversion and Misuse

A Review of Buprenorphine Diversion and Misuse

Buprenorphine Prescribing: To Expand or Not to Expand

Substance Abuse: Opioid‐Related Disorders

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