Buprenorphine Use and Risk of Abuse and Diversion

Opioid maintenance therapy with methadone or buprenorphine is a well-established first-line treatment for opio- id dependence. However, risk of diversion and drug-related mortality are critical issues during maintenance therapy. These issues are discussed controversially in both the scientific and public arenas and are a matter of concern also among medical authorities. In addition to a formulation containing buprenorphine alone, a combination formulation with buprenorphine and naloxone in a 4:1 ratio is available. The combination formulation was developed with the aim to prevent intravenous use or diversion. This critical review summarizes data on the risk of abuse and diversion of buprenorphine.