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The More Things Change

Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible

Carroll, Jennifer J., PhD, MPH; Rich, Josiah D., MD, MPH; Green, Traci C., PhD, MSc

doi: 10.1097/ADM.0000000000000436
Original Research

Objectives: Buprenorphine/naloxone, an evidence-based treatment for opioid use disorder, is sometimes diverted for non-medical use. In Rhode Island, the prevalence of opioid use and, more recently, of fentanyl in the illicit drug supply is driving overdose fatalities, which increases the need for treatment and raises questions about the changing role of diverted medication in shaping overdose risk.

Methods: This study considered data from 2 Rhode Island based studies (conducted in 2009 and 2016, respectively) of people who use illicit or diverted prescription opioids and their patterns of buprenorphine/naloxone diversion. Using targeted sampling, individuals who use opioids completed a brief questionnaire about their drug use. For the 2016 study, logistic regression was used to identify associations with recent and lifetime use of diverted medication.

Results: A total of 128 individuals who use opioids non-medically participated in the 2016 study. Of these, 38% (n = 13) reported diverted buprenorphine/naloxone use in the past 2 months, similar to the pattern observed in 2009 (41%, n = 41). Common motivations for using diverted medication included the management of withdrawal symptoms (40%, n = 35) and self-treatment of opioid use disorder (39%, n = 34). Few reported using to “get high” (12%, n = 4). Seeking buprenorphine/naloxone treatment in the previous 12 months was positively associated with using diverted medication in the past 2 months (odds ratio = 5.14, 95% confidence interval = 1.0–26.5, P = 0.05). Participants of both studies reported the same barriers to care in 2009 and 2016.

Conclusion: The use of diverted/buprenorphine remains common among people who use opioids non-medically and indicates a severe shortage in treatment capacity and inaccessibility of existing services.

The Warren Alpert School of Medicine of Brown University (JJC, JDR, TCG); Division of Infectious Diseases, The Miriam Hospital, Providence, RI (JDR); Department of Emergency Medicine, Rhode Island Hospital and Boston Medical Center, Boston, MA (TCG).

Send correspondence to Jennifer J. Carroll, PhD, MPH, 164 Summit Ave, CFAR Building, Rm 134, Providence, RI 02906. E-mail:

Received 19 January, 2018

Accepted 17 May, 2018

Funding for this study was provided by CVS Health for the Rhode Island Governors Task Force on Overdose and Addiction. This research has been facilitated in part by the infrastructure and resources provided by the Providence/Boston Center for AIDS research, an NIH-funded program, grant number P30-AI-42853, from the National Institutes of Health, Center for AIDS Research. This research was also supported by the National Institute on Drug Abuse (Award Numbers T32 DA013911, K24 DA022112 and R21 DA045858) and by the U.S. Centers for Disease Control and Prevention (NU17CD002740).

The authors have no conflicts of interest to disclose.

© 2018 American Society of Addiction Medicine