Suboxone Abuse and Diversion

It seems lately Buprenorphine (Suboxone) has come under fire for abuse and diversion potential.  There is no doubt that buprenorphine has abuse potential given the epidemic opiates have created for this nation.  Let's examine the facts about possible abusers of buprenorphine as well as buprenorphine's unique pharmacology. Understanding some key facts will allow a better understanding of possible Suboxone abuse and diversion.


SOURCES OF DIVERSION
Buprenorphine (whether it be buprenorphine alone or the popular buprenorphine/naloxone combination) is undoubtedly most commonly prescribed for opioid dependence applications.  Therefore, the patient should be well aware of it's effects and the medication should be stored accordingly.  Assuming appropriate responsibility on the patient's part, diversion through medicine cabinet raids is not likely to be as high as with post-surgery opiates.  It would seem that medicine cabinet diversion would also be tied to adolescent abuse at a higher rate.  In other words, with responsible buprenorphine patients, teenagers raiding medicine cabinets for buprenorphine is not likely a common source of diversion.

So what is likely to be the most common source of diversion?  Street distribution of buprenorphine by patients would likely top that list.  Problem is, given the fact that user's cannot achieve a "high" from buprenorphine after the first few uses, it doesn't seem to be an attractive option for occasional recreational opiate users.  It is safe to assume that buprenorphine is most commonly diverted for self-medicating individuals seeking opiate replacement.  Granted, many of these self-medicating individuals are not serious about long term opiate replacement, they simply are using buprenorphine to escape the detox of another opiate.  Some diversion of buprenorphine is undoubtedly essentially using the drug just as a physician would prescribe it to be used in a medical setting.  This may be a hard idea to grasp, but buprenorphine is an expensive treatment plan for uninsured individuals. Also, buprenorphine can be effectively used for opiate replacement using a tiny fraction of the huge doses physicians often prescribe.

BUPRENORPHINE PHARMACOLOGY
The unique pharmacology of buprenorphine means that overdose deaths are rare, extremely rare when no other drugs were used in conjunction with buprenorphine.  A large majority of buprenorphine associated deaths were because of mixing benzodiazapines like xanax together with the medication.

Buprenorphine has a ceiling effect, unlike other opiates/opioids.  This means that at a certain dose, increased dosing with have no further effect on the body.  Therefore, it is much safer compared to nearly any other opiate/opioid.

CONCLUSION
There is no doubt diversion of buprenorphine is happening.  Examining the facts surrounding the drug and likely users of diverted buprenorphine, helps understand risks associated with it.  In today's world, nearly all prescriptions scheduled above schedule 5 are likely diverted at some rate.  If diversion and abuse of one drug is so alarming, why not focus on the root cause of all diversion and a solution to the high rates its happening.

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