Buprenorphine Use and Risk of Abuse and Diversion

Opioid dependence is a chronic relapsing disorder with an excess mortality rate [1-4]. Over than 90% of the estimates relate to heroin, as demonstrated in a global literature review by Degenhardt et al. [5]. Opioid maintenance treatment has proven efficacy in reducing opioid consumption and psychosocial and medical morbidity and in increasing treatment retention rates and social functioning in opioid addicts [6]. Nevertheless, 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]. Usually, it is defined as the unauthorized re-routing or appropriation of a drug. Misuse, 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]. Other considerations include a possible negative impact on the prescribers’ practice, threatened reputation of treatment services, and compromised public acceptance for the drug and maintenance treatment [17], as is currently the case in Austria, for example. The economic costs of the non-medical use of prescription opioids are enormous [18].