U.S. Treatment Applicants Report Buprenorphine/Naloxone Sold on Street; One-Fifth Report the Drug Is Used to Get High

“Diversion and abuse of buprenorphine/naloxone have steadily increased since 2005 through 2009,” according to data from a national post-marketing surveillance program* funded by the manufacturer. One of the indicators of diversion and abuse utilized by the surveillance program is a survey of nearly 19,000 applicants to 86 substance abuse treatment programs in 30 states.

Both the percentage of applicants who reported knowing that buprenorphine/naloxone, which has been approved for opioid therapy since 2002, was sold on the street and those that reported knowing that the drug was used to get high increased from 2005 to 2009, reaching 33% and 21%, respectively. In comparison, the percentage who reported that methadone, which has been used since the 1950s for opioid therapy, was sold on the street or used to get high has remained relatively stable over the past three years (see figure below). The authors note that “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.”

Percentage of Applicants to U.S. Treatment Programs Who Knew of
Methadone and Buprenorphine/Naloxone Being Sold on the Street or Being Used to Get High, 2005-2009
(n=18,956 from 2005 to 2009)

*Conducted for Reckitt Benckiser Pharmaceuticals by an independent contractor, the Surveillance of Diversion and Abuse of Therapeutic Agents (SODATA) utilizes several national indicators of diversion and abuse combined with a survey of applicants to substance abuse treatment programs and a survey of CSAT-certified physicians.

**Surveys were conducted at 86 treatment programs (both providing and not providing pharmacotherapy) from 30 states providing a total of 18,956 completed surveys from 2005 to 2009. While the treatment applicant survey was not a probability sample, the demographic characteristics of the applicant sample were similar to that of the national census of publicly-funded treatment admissions. The applicant survey does not estimate either the incidence or the prevalence of diversion/abuse, but it is an indication of changes in perception of diversion/abuse among a population likely to be knowledgeable about illegal markets through their own experiences, that of others, and direct observations.

See Wish, ED, Artigiani, E, Billing, A, Hauser, W, Hemberg, J, Shiplet, M, and DuPont, R, “The Emerging Buprenorphine Epidemic in the United States,” Journal of Addictive Diseases 31(1):3-7, 2012 for more information on buprenorphine diversion and abuse.

Source: Cesar Fax – June 25, 2012

Comments

  1. Robert Schafer says:

    My experience as both a current healthcare provider and a former methadone client has been that the diversion of both methadone and buprenorphine by clients are mainly due to the high cost of treatment programs. It was more likely than not, when I was a client, that methadone clients would sell one dose of their take-outs in order to pay the $70 -$80 weekly clinic fee for the next week. I have heard from current buprenorphine clients that it is also the high cost of treatment that is at least a partial reason for them selling doses. It would be interesting to study whether free or low-cost clinics had lower diversion rates than unsubsidized, high-cost clinics. Another observation, almost all of those I was aware of diverting their doses, sold them to other clients or at least to others that weren’t methodone/buprenorphine naive.

  2. Michele DiLauro says:

    We frequently admit clients for bupenorphine treatment at our clinic who previously have seen private MD’s. I often see prescriptions written for 3 and occationally 4 tabs (strips) a day. I’d say 99% of anything above 2 a day lands on the street. Given the drugs pharmacology perhaps we need to look at fill limits per # of days?

    • Robert Oelhaf says:

      I am personally in favor of a grams per provider per year cap with an infinite patient number per provider. The goal would be an economic drive for the provider to cut someone’s dose to allow another patient to legally enter the practice. 584 grams per year per provider is 16 mg x 100 patients x 365 days.

  3. Robert Oelhaf says:

    Clearly, more investigation is needed into the economics of black market buprenorphine cooperatives. I also object to the word “high” as uscientific and outdated.

  4. Robert Oelhaf says:

    If you could please change that to”unscientific” I would be very grateful, thank you.

  5. The vast majority of buprenorphine diversion that we have seen here in Rhode Island is being used to self medicate in the treatment of withdrawal symptoms. Much of the harm done to self and others occurs during times of desperation, to avoid those symptoms. It is clearly better to have someone take some diverted buprenorphine than go and rob the corner store. However, there is a real concern about diversion leading to new initiates through buprenorphine. Clearly some balance is needed, but, we should not assume that short term or intermittent use of buprenorphine is not beneficial.
    Thank you
    Jody Rich

  6. Um, if they sold suboxone over the counter on an unlimited basis would that really be such a bad thing?

  7. It is interesting that the manufacturer is funding an “independent investigator” to look at buprenorphine diversion and misuse. Buprenorphine if used correctly has helped thousands of people. With any pharmaceutical that has potential for misuse, there are going to be problems. In my practice I have observed some who have even given some of their buprenorphine to a family member or spouse just to keep them from withdrawals. Its survival. I believe if greater access and low cost treatment were available this would not happen. Ask any opiate depedent patient, if they are going to “get high”, they aren’t going to waste their time with a partial agonist. They want the real thing. The makers of Suboxone are just focusing on a small number of people whom may try to abuse it for one thing only; to keep the cheaper generic from being sold. It’s all about the money and greed. I do not see anyone trying to browbeat all the pain meds and xanax out there. All nonsense. There is an opioid epidemic out there and people need low cost solutions. Get the generic out there and it will save the taxpayers millions. Quit letting pharma maximize their profits.

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