JAM study highlights emerging problem in addiction therapy

A Journal of Addiction Medicine (JAM) study was cited in a recent Center for Substance Abuse Research (CESAR) series highlighting an emerging problem in addiction therapy: the diversion and misuse of the medication buprenorphine. The official journal of the American Society of Addiction Medicine, JAM is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The citation appeared in last year's "CESAR FAX" special series on buprenorphine. The editors of CESAR FAX, a weekly update on substance abuse research, wrote, "While research indicates that buprenorphine is an effective drug for treating opioid dependence, we feel that the potential for its nonmedical use and related unintended consequences may be going unnoticed."

Differing Patterns of Buprenorphine Mis-use
Buprenorphine is used in the medical treatment of people addicted to opioids—particularly prescription opioids and heroin. As buprenorphine is more widely prescribed, there may be increasing problems with diversion and misuse.

In the study, researchers at Brown University analyzed patterns of buprenorphine abuse by intravenous (IV) and non-IV opioid users in Providence, R.I. They found that about three-fourths of these opioid users were obtaining buprenorphine-containing medications illicitly.

The study also found that the two groups were using buprenorphine in different ways. The IV drug users most often took buprenorphine for self-medication—for example, to remedy withdrawal symptoms or to "self-treat" their addiction.

In contrast, non-IV drug users were more likely to say they took the diverted buprenorphine to "get high." That was a surprise, because buprenorphine-containing medications aren't expected to produce a "high" in regular users who have built up a tolerance to opioids.

"We believe the results are noteworthy because they are the first to suggest that individual drug use patterns and the severity of opioid dependence may be related to an individual's motivation for using diverted buprenorphine," the CESAR FAX editors write. They suggest some policy changes that might help to decrease buprenorphine diversion and misuse.

"We are pleased that one of our papers was included in the CESAR FAX series, and we hope it will help to draw attention to this emerging issue," comments Shannon C. Miller, M.D., FASAM, FAPA of the Cincinnati VA and the University of Cincinnati's Center for Treatment, Research, and Education in Addictive Disorders (CeTREAD), and co-editor of JAM. "The diversion and misuse of buprenorphine is of concern to clinicians. This work is important in developing strategies to decrease illicit availability of this effective medication," notes Martha J Wunsch MD FASAM, Co-Editor of JAM. The researchers at Brown University have made a high impact contribution to the field."