title: Recognizing Potential Buprenorphine Medication Misuse: Product Packaging Does Not Degrade With Laundering.
abstract: BACKGROUND
  Expanded office-based buprenorphine opioid dependence treatment is associated with medication misuse and diversion consequences. Recurrent early refill requests may indicate misuse or diversion, although further research is needed on how to effectively recognize and address the issue in clinical practice. In the current study, patient report of damaged medication from laundering prompted evaluation of laundering on degradation of buprenorphine-containing product packages and contents.
  
  
  METHODS
  Four buprenorphine product packaging approaches were assessed: 3 buprenorphine/naloxone placebo demonstration products (Suboxone and Bunavail film in foil wrappers and Zubsolv tablet in a blister pack) and Rexam-manufactured Screw-Loc closure pill container filled with a chewable aspirin as a surrogate for generic buprenorphine and buprenorphine/naloxone products. Two experimental laundering conditions, wash machine alone (W) and washer/dryer (W+D), were compared with unlaundered control (C) condition. Standard laundering settings were based on patient presentation. Products from the 2 experimental conditions and the control condition were labeled A, B, or C with counterbalanced assignment prior to visual examination of packaging and contents by the investigator who was blinded to condition.
  
  
  RESULTS
  Packaging and contents remained intact for all products across experimental conditions, with only minor cosmetic effects compared with control. The W+D Suboxone film had 1-2 mm curling of the wrapper corners. Zubsolv blister packs had slight paper label fading (W+D > W). Bunavail W+D foil had an indentation outlining the inner film. The W+D bottle tablet had a ˜1 mm nick on one edge. No other differences were noted. After implementing more structured treatment and reviewing the results with the patient, he endorsed fabricating the laundering story to get additional medication.
  
  
  CONCLUSIONS
  Laundering is an unlikely cause of damaged buprenorphine-containing medication packaged in foil wrappers (Suboxone, Bunavail), blister pack (Zubsolv), or prescription pill bottle (generic buprenorphine or buprenorphine/naloxone products). Patient reports of such may indicate medication misuse or diversion.
authors: a Department of Psychiatry and Neurobehavioral Sciences, Department of Medicine , University of Virginia , Charlottesville , Virginia , USA.
authors: Erik W
authors: EW
authors: Gunderson
mesh_terms: D002047:Buprenorphine / Q000009:adverse effects*; D000069479:Buprenorphine, Naloxone Drug Combination; D006801:Humans; D007846:Laundering; D009292:Narcotic Antagonists / Q000009:adverse effects; D064226:Prescription Drug Diversion / Q000517:prevention & control*; D019064:Product Packaging; D019966:Substance-Related Disorders / Q000517:prevention & control*
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D002047:Buprenorphine
keywords: Buprenorphine; prescription drug diversion; prescription drug misuse