Buprenorphine Diversion and Misuse in Outpatient Practice

Lofwall, Michelle R.; Martin, Judith; Tierney, Matt; Fatséas, Mélina; Auriacombe, Marc; Lintzeris, Nicholas

doi:10.1097/adm.0000000000000029

Cited by 6 publications

(2 citation statements)

References 15 publications

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“…Whereas most people who use buprenorphine extramedically do so irregularly and to manage or mitigate opioid cravings or withdrawal [33,45,[54][55][56], our findings demonstrate that there is a smaller subset of persons who inject extramedical buprenorphine for its reinforcing properties. The use of buprenorphine in this way across multiple jurisdictions suggests that BUP iOAT may be an acceptable treatment option for persons with severe, refractory OUD that is non responsive to traditional OAT, or who are not interested in OAT.…”

Section: Discussionmentioning

confidence: 74%

Patterns of use and adverse events reported among persons who regularly inject buprenorphine: a systematic review

Bozinoff

Tardelli²,

Rubin-Kahana³

et al. 2022

Harm Reduct J

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Background and Aims Given the ongoing opioid crisis, novel interventions to treat severe opioid use disorder (OUD) are urgently needed. Injectable opioid agonist therapy (iOAT) with diacetylmorphine or hydromorphone is effective for the treatment of severe, treatment-refractory OUD, however barriers to implementation persist. Intravenous buprenorphine for the treatment of OUD (BUP iOAT) has several possible advantages over traditional iOAT, including a safety profile that might enable take-home dosing. We aimed to characterize injecting practices among real-world populations of persons who regularly inject buprenorphine, as well as associated adverse events reported in order to inform a possible future BUP iOAT intervention. Methods We conducted a systematic review. We searched MEDLINE, EMBASE, and PsycINFO from inception through July 2020 and used backwards citation screening to search for publications reporting on dose, frequency among persons who regularly inject the drug, or adverse events associated with intravenous use of buprenorphine. The review was limited to English language publications and there was no limitation on study type. Study quality and risk of bias was assessed using the Mixed Methods Appraisal Tool. Narrative synthesis was used in reporting the results. Results Eighty-eight studies were included in our review. Regular injection of buprenorphine was identified across diverse settings world-wide. Daily dose of oral buprenorphine injected was < 1–12 mg. Frequency of injection was 0–10 times daily. Adverse events could be characterized as known side effects of opioids/buprenorphine or injection-related complications. Most studies were deemed to be of low quality. Conclusions Extramedical, intravenous use of buprenorphine, continues to be documented. BUP iOAT may be feasible and results may inform the development of a study to test the efficacy and safety of such an intervention. Future work should also examine acceptability among people with severe OUD in North America. Our review was limited by the quality of included studies.

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Section: Discussionmentioning

confidence: 74%

Patterns of use and adverse events reported among persons who regularly inject buprenorphine: a systematic review

Bozinoff

Tardelli²,

Rubin-Kahana³

et al. 2022

Harm Reduct J

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“…63,64 In international locations where the prevalence of buprenorphine monotherapy use was greater, there is clear evidence of the risk of misuse, abuse, and diversion of daily sublingual formulations of buprenorphine. [65][66][67] A study conducted in Australia comparing rates of abuse of buprenorphine, buprenorphine/naloxone, and methadone formulations found significantly lower rates of abuse for the combined buprenorphine/naloxone formulation compared to the monotherapy buprenorphine or methadone. 68 In a Finnish study where rates of buprenorphine abuse and diversion were exceptionally high, the introduction of buprenorphine/naloxone formulation was noted to decrease use.…”

Section: Sublingual Tablets (Subutex®)mentioning

confidence: 99%

Buprenorphine and its formulations: a comprehensive review

Poliwoda

Noor

Jenkins

et al. 2022

Health Psychology Research

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Buprenorphine, a novel long-acting analgesic, was developed with the intention of two purposes: analgesia and opioid use disorder. Regarding its pharmacodynamics, it is a partial agonist at mu receptors, an inverse agonist at kappa receptors, and an antagonist at delta receptors. For the purpose of analgesia, three formulations of buprenorphine were developed: IV/IM injectable formulation (Buprenex®), transdermal patch formulation (Butrans®), and buccal film formulation (Belbuca®). Related to opioid dependence, the formulations developed were subcutaneous extended release (Sublocade®), subdermal implant (Probuphine®), and sublingual tablets (Subutex®). Lastly, in order to avoid misuse of buprenorphine for opioid dependence, two combination formulations paired with naloxone were developed: film formulation (Suboxone®) and tablet formulation (Zubsolv®). In this review, we present details of each formulation along with their similarities and differences between each other and clinical considerations.

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