Abstract
Opioid maintenance therapy with methadone or buprenorphine is a well-established first-line treatment for opio- id dependence. However, risk of diversion and drug-related mortality are critical issues during maintenance therapy. These issues are discussed controversially in both the scientific and public arenas and are a matter of concern also among medical authorities. In addition to a formulation containing buprenorphine alone, a combination formulation with buprenorphine and naloxone in a 4:1 ratio is available. The combination formulation was developed with the aim to prevent intravenous use or diversion. This critical review summarizes data on the risk of abuse and diversion of buprenorphine.
Highlights
Opioid dependence is a chronic relapsing disorder with an excess mortality rate [1,2,3,4]
Risks of diversion and misuse include increased patient morbidity and mortality [10], overdose and fatal respiratory depression [11,12], non-fatal overdose and related emergency admissions [10], blood-borne viruses and infections [13,14], and numerous other complications associated with injection drug use [15,16]
Data from France from 2006 show that up to 25% of French buprenorphine doses were diverted into the black market (Narcotics Control Board 2006)
Summary
Opioid dependence is a chronic relapsing disorder with an excess mortality rate [1,2,3,4]. There are persistent and in part increasing concerns about diversion of maintenance drugs, concomitant drug use, and mortality in opioid-maintained patients [1,7,8]. Diversion may be understood differently by clinicians and patients [9] It is defined as the unauthorized re-routing or appropriation of a drug. On the other hand, is defined as any use of a prescription drug that deviates from medical practice. Risks of diversion and misuse include increased patient morbidity and mortality [10], overdose and fatal respiratory depression [11,12], non-fatal overdose and related emergency admissions [10], blood-borne viruses and infections [13,14], and numerous other complications associated with injection drug use [15,16]. The economic costs of the non-medical use of prescription opioids are enormous [18]
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