title: Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: an international review.
abstract: The diversion, misuse, and non-medically supervised use of buprenorphine and buprenorphine/naloxone by opioid users are reviewed. Buprenorphine and buprenorphine/naloxone are used globally as opioid analgesics and in the treatment of opioid dependency. Diversion of buprenorphine and buprenorphine/naloxone represents a complex medical and social issue, and has been widely documented in various geographical regions throughout the world. We first discuss the clinical properties of buprenorphine and its abuse potential. Second, we discuss its diversion and illicit use on an international level, as well as motivations for those activities. Third, we examine the medical risks and benefits of buprenorphine's non-medically supervised use and misuse. These risks and benefits include the effect of buprenorphine's use on HIV risk and the risk of its concomitant use with other medications and drugs of abuse. Finally, we discuss the implications of diversion, misuse, and non-medically supervised use (including potential measures to address issues of diversion); and potential areas for further research.
authors.affiliation: Division of Infectious Diseases, The Miriam Hospital, Providence, RI 02906, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Yokell
authors.forename: Nickolas D
authors.initials: ND
authors.lastname: Zaller
authors.forename: Traci C
authors.initials: TC
authors.lastname: Green
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Rich
mesh_terms: D002047:Buprenorphine / Q000009:adverse effects* / Q000627:therapeutic use; D062787:Drug Overdose; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D013287:Illicit Drugs; D009042:Motivation; D009270:Naloxone / Q000009:adverse effects* / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D009294:Narcotics / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D012309:Risk-Taking
chemical_list: D013287:Illicit Drugs; D009292:Narcotic Antagonists; D009294:Narcotics; D009270:Naloxone; D002047:Buprenorphine