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Commentary on “The More Things Change

Buprenorphine/Naloxone Diversion Continues While Treatment is Inaccessible”

Mitchell, Shannon Gwin, PhD; Gryczynski, Jan, PhD; Schwartz, Robert P., MD

doi: 10.1097/ADM.0000000000000437

This commentary puts the recent findings by Carroll et al into historical perspective, noting both the long-held problem of medication diversion when pharmacotherapy access is limited, and the ways in which medication diversion concerns and regulations help create those treatment access barriers. Recent efforts to bridge the treatment gap, including increases in Federal funding through the 21st Century Cures Act and expanding the buprenorphine patient cap and scope of eligible providers under the Comprehensive Addiction Recovery Act (CARA) will likely help; however, important structural barriers remain. Health insurance barriers, including limited Medicaid coverage, combined with stigma against pharmacotherapy persist, which likely means that people in need of treatment will continue to self-treat their symptoms with diverted medications, such as the buprenorphine/naloxone use noted by Carroll and colleagues.

Friends Research Institute, Baltimore, MD.

Send correspondence to Shannon Gwin Mitchell, PhD, 1040 Park Avenue, Suite 103, Baltimore, Maryland 21201. E-mail:

Received 27 June, 2018

Accepted 3 July, 2018

Dr Schwartz is a consultant for Verily Life Sciences. Dr Gryczynski is part owner of COG Analytics LLC, which has received funding from NIH for development of screening and intervention technologies. Dr Mitchell reports no conflicts of interest.

Funding support was provided by the National Institute on Drug Abuse 5R01DA033391-05.

© 2018 American Society of Addiction Medicine