title: Diversion and abuse of buprenorphine: findings from national surveys of treatment patients and physicians.
abstract: BACKGROUND
  Since 2003, buprenorphine has been approved for the treatment of opioid dependence in office-based practice. Diversion and abuse can be a threat to its continued approval under these conditions.
  
  
  METHODS
  As part of a national postmarketing surveillance program, applicants to substance abuse treatment and physicians certified to prescribe buprenorphine were surveyed about their perceptions of buprenorphine/naloxone diversion and abuse. These surveys were supplemented by information from national databases. Availability of buprenorphine/naloxone was measured by number of tablets dispensed.
  
  
  RESULTS
  Measures of diversion and abuse of buprenorphine/naloxone increased from 2005 to 2009. The results from the applicant survey showed that the perceptions of the extent of diversion and abuse were lower than positive controls, methadone, oxycodone and heroin, but higher than the negative control, amitriptyline. By 2009, 46% of the physicians believed that buprenorphine/naloxone was diverted but 44% believed illegal use was for self-management of withdrawal and 53% believed the source of the medication was substance abuse patients. Other measures from national databases showed similar results. When adjusted for millions of tablets sold per year, slopes for measures of diversion and abuse were reduced.
  
  
  CONCLUSIONS
  The increases in diversion and abuse measures indicate the need to take active attempts to curb diversion and abuse as well as continuous monitoring and surveillance of all buprenorphine products. However, these increases parallel the increased number of tablets sold. Finding a balance of risk/benefit (i.e. diversion and abuse versus expanded treatment) remains a challenge.
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 2761 E. Jefferson Ave., Detroit, MI 48207, USA. cjohans@med.wayne.edu
authors.forename: Chris-Ellyn
authors.initials: CE
authors.lastname: Johanson
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Arfken
authors.forename: Salvatore
authors.initials: S
authors.lastname: di Menza
authors.forename: Charles Roberts
authors.initials: CR
authors.lastname: Schuster
mesh_terms: D001291:Attitude of Health Personnel; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009270:Naloxone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods / Q000706:statistics & numerical data; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000209:etiology; D010820:Physicians; D014481:United States / Q000453:epidemiology
chemical_list: D009294:Narcotics; D009270:Naloxone; D002047:Buprenorphine