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Buprenorphine Diversion and Misuse in Outpatient Practice

Lofwall, Michelle R. MD; Martin, Judith MD; Tierney, Matt NP, CNS; Fatséas, Mélina MD, MPH; Auriacombe, Marc MD, MSc; Lintzeris, Nicholas PhD, FAChAM

doi: 10.1097/ADM.0000000000000029
Clinical Case Conference

This case is an amalgamation of several real patients in office-based treatment for prescription opioid dependence synthesized into a single theoretical case. The case illustrates the various ways in which medication diversion and misuse may be encountered in clinical practice and therapeutic responses designed to maximize positive treatment outcomes. It is followed by discussions from several expert addiction medicine providers from 3 different countries, giving their perspectives on the salient aspects of this case. This case conference should be of particular interest to clinicians working with opioid-dependent patients in an outpatient setting.

From the Departments of Behavioral Science and Psychiatry (MRL), Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington; Department of Public Health (JM), City and County of San Francisco, San Francisco, CA; Office-Based Buprenorphine Induction Clinic and Centralized Opiate Placement Evaluation Clinics (MT), Division of Substance Abuse and Addiction Medicine, Department of Psychiatry, San Francisco General Hospital, San Francisco, CA; Université de Bordeaux (Segalen) and Laboratoire de psychiatrie/SANPSY (MF, MA), CNRS USR 3413, Bordeaux, France, and Département d'Addictologie (MF, MA), CH Charles Perrens and CHU de Bordeaux, Bordeaux, France; Drug & Alcohol Services (NL), South East Sydney Local Health District, Caringbah, New South Wales, Australia; NSW Ministry of Health (NL), Sydney, New South Wales, Australia; and University of Sydney (NL), Darlington New South Wales, Australia.

Send correspondence and reprint requests to Michelle R. Lofwall, MD, Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, 515 Oldham Court, Lexington, KY 40502. E-mail:

The authors declare no conflicts of interest.

There was no funding source for this case conference. Drs Lofwall, Lintzeris, and Auricombe are on the steering committee for the European Quality Patient Care Network that is part of PCM Scientific (a British educational company). Drs Lofwall, Lintzeris, and Auricombe have received payment from PCM Scientific for developing educational materials and giving educational talks. Dr Auriacombe is a consultant for RBK Pharmaceuticals, D & A Pharma, and Mundipharma, and he has received a grant from RBK (these payments go to his institution). Dr Lintzeris has received an educational grant from Reckitt Benckiser (payment goes to his institution). Drs Fatseas and Martin have no conflicts. Dr Lofwall has been a consultant for Orexo Pharmaceuticals and has received research contract funding from CRS Associates in the past (contract funding goes to her institution). Mr Tierney has received payment for development of educational programs by CMELLC and for expert testimony for Lanzone Morgan LLP.

Received November 26, 2013

Accepted January 17, 2014

© 2014 American Society of Addiction Medicine