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Heroin Addiction and Related Clinical Problems: 2018, 20, N3 (pages: 51 - 58)

Diversion of Buprenorphine: Scope of the Problem and the Measures Taken to Address It

Tripathi R., and Sarkar S.

Summary: Background: Opioid dependence is a matter of public health concern globally. Opioid substitution therapy is recommended as one of the most effective treatment strategies to manage opioid use disorder. As a partial opioid agonist, buprenorphine is widely used all over the world for opioid substitution therapy. Clinical use of buprenorphine is often coupled with instances of diversion and misuse of this medication. There can be multiple reasons and motives for diversion. Methods: In this paper, we assess the various reasons for, and the effects of diversion, along with the range of mitigation strategies adopted to reduce /that diversion. Results: The potential methods that can be utilized for reducing diversion include improving medication adherence, adequate dosing, supervision of dosing, being cautious of possible diversion at clinical visits, termination of treatment in selected cases, provision of confidential treatment in specific situations, random urine screening, prescription monitoring, utilizing alternative formulations of buprenorphine, and scaling up of opioid substitution (treatment. Conclusion: The concerns often expressed about diversion should not be allowed to become a deterrent against the rational use of buprenorphine for opioid substitution, though reflective and corrective measures are needed once diversion has been detected.