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Illicit Use of Buprenorphine/Naloxone Among Injecting and Noninjecting Opioid Users

Bazazi, Alexander R. BA; Yokell, Michael ScB; Fu, Jeannia J. ScB; Rich, Josiah D. MD, MPH; Zaller, Nickolas D. PhD

doi: 10.1097/ADM.0b013e3182034e31
Original Research

Objectives: We examined the use, procurement, and motivations for the use of diverted buprenorphine/naloxone among injecting and noninjecting opioid users in an urban area.

Methods: A survey was self-administered among 51 injecting opioid users and 49 noninjecting opioid users in Providence, RI. Participants were recruited from a fixed-site syringe exchange program and a community outreach site between August and November 2009.

Results: A majority (76%) of participants reported having obtained buprenorphine/naloxone illicitly, with 41% having done so in the previous month. More injection drug users (IDUs) than non-IDUs reported the use of diverted buprenorphine/naloxone (86% vs 65%, P = 0.01). The majority of participants who had used buprenorphine/naloxone reported doing so to treat opioid withdrawal symptoms (74%) or to stop using other opioids (66%) or because they could not afford drug treatment (64%). More IDUs than non-IDUs reported using diverted buprenorphine/naloxone for these reasons. Significantly more non-IDUs than IDUs reported ever using buprenorphine/naloxone to “get high” (69% vs 32%, P < 0.01). The majority of respondents, both IDUs and non-IDUs, were interested in receiving treatment for opioid dependence, with greater reported interest in buprenorphine/naloxone than in methadone. Common reasons given for not being currently enrolled in a buprenorphine/naloxone program included cost and unavailability of prescribing physicians.

Conclusions: The use of diverted buprenorphine/naloxone was common in our sample. However, many opioid users, particularly IDUs, were using diverted buprenorphine/naloxone for reasons consistent with its therapeutic purpose, such as alleviating opioid withdrawal symptoms and reducing the use of other opioids. These findings highlight the need to explore the full impact of buprenorphine/naloxone diversion and improve the accessibility of buprenorphine/naloxone through licensed treatment providers.

From the Division of Infectious Diseases and the Center for Prisoner Health and Human Rights (ARB, MY, JJF, JDR, NDZ), The Miriam Hospital, Providence, RI; Yale School of Medicine (ARB), New Haven, CT; and Warren Alpert Medical School of Brown University (JDR, NDZ), Providence, RI.

Send correspondence and reprint requests to Nickolas D. Zaller, PhD, The Miriam Hospital, 164 Summit Avenue, RISE/CFAR Room 109, Providence, RI 02906. E-mail:

Supported by grant P30-AI-42853 from the National Institutes of Health, Center for AIDS Research (NIH/CFAR), P30DA013868 from the Center for Drug Abuse and AIDS Research (CDAAR), R01DA018641 and K24DA022112 from the National Institute on Drug Abuse, NIH (NIDA/NIH).

The content is solely the responsibility of the authors and does not necessarily represent the official views of NIDA or the NIH.

Received July 23, 2010

Accepted October 24, 2010

© 2011 American Society of Addiction Medicine