The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible.

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.