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Use and misuse of buprenorphine in the management of opioid addiction

Theodore J. Cicero, PhD, Hilary L. Surratt, PhD, James Inciardi, PhD


Buprenorphine was approved in late 2004 for the treatment of opioid abuse and dependence in specially trained and certified physicians’ offices. At the time of the approval, there was a regulatory concern that given the anticipated wide exposure there would be unexpectedly high levels of abuse in the high-risk population for which it was intended. To assess its abuse potential, the authors recruited more than 1,000 individuals seeking treatment for prescription opioid abuse from 100 stand-alone (ie, self-pay or insurance) drug abuse treatment programs around the country to determine whether they misused buprenorphine in the past 30 days to get high. The results indicate that there was a time-related increase in the number of subjects who used burprenorphine to get high, reaching 30-35 percent of individuals completing a questionnaire in the second quarter of 2006. At this time, it was equivalent to the misuse of methadone, both of which, however, were considerably lower than hydrocodone and oxycodone. Thereafter, the number of individuals using buprenorphine to get high dropped in a near linear fashion to less than 20 percent of those completing a questionnaire in the second quarter of 2007, significantly lower than that for methadone, oxycodone, and hydrocodone. The most likely interpretation of these data is that the polysubstance- abusing population, for whom buprenorphine is intended, experimented with this medication for its mood-altering effects for a period of time, but presumably because of its lack of euphorogenic properties, its use has now dissipated. Additionally, support for this conclusion is the very rare endorsement of buprenorphine as a primary drug (<3 percent of the total sample). Thus, the results indicate that it is unlikely that buprenorphine abuse will ever reach the epidemic that was feared by some regulatory groups and that its use in opioid detoxification and maintenance should continue.


buprenorphine abuse, buprenorphine misuse, prescription opioid abuse, treatment, opioid abuse

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Fudala PJ, Bridge TP, Herbert S, et al.: Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. N Engl J Med. 2003; 349(10): 949-958.

Fiellin DA, O’Connor PG.: New federal initiatives to enhance the medical treatment of opioid dependence. Ann Intern Med. 2002; 137(8): 688-692.

Fiellin DA, Pantalon MV, Chawarski MC, et al.: Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence. N Engl J Med. 2006; 355(4): 365-374.

Comer SD, Collins ED, Fischman MW.: Intravenous buprenorphine self-administration by detoxified heroin abusers. J Pharmacol Exp Ther. 2002; 301(1): 266-276.

Pickworth WB, Johnson RE, Holicky BA, et al.: Subjective and physiologic effects of intravenous buprenorphine in humans. Clin Pharmacol Ther. 1993; 53(5): 570-576.

Mendelson J, Jones RT.: Clinical and pharmacological evaluation of buprenorphine and naloxone combinations: Why the 4:1 ratio for treatment? Drug Alcohol Depend. 2003; 70(2S): S29-S37.

Fudala PJ, Yu E, Macfadden W, Boardman C, Chiang CN.: Effects of buprenorphine and naloxone in morphine-stabilized opioid addicts. Drug Alcohol Depend 1998; 50(1): 1-8.

Mendelson J, Jones RT, Welm S, et al.: Buprenorphine and naloxone combinations: The effects of three dose ratios in morphine-stabilized, opiate-dependent volunteers. Psychopharmacology (Berl). 1999; 141(1): 37-46.

Drug Addiction Treatment Act of 2000.: Public Law No. 106-310, Title XXXV-Waiver authority for physicians who dispense or prescribe certain narcotic drugs for maintenance treatment or detoxification treatment. Available at Accessed July 22, 2001.

Cicero TJ, Inciardi JA.: Potential for abuse of buprenorphine in office-based treatment of opioid dependence. N Engl J Med. 2005; 353(17): 1863-1865.

Cicero TJ, Surratt H, Inciardi JA, Munoz A.: Relationship between therapeutic use and abuse of opioid analgesics in rural, suburban, and urban locations in the United States. Pharmacoepidemiol Drug Saf 2007; 16(8): 827-840.

Treatment Episode Data Set (TEDS): 1994-2004 Drug and Alcohol Services Information System Series S-33, Department of Health and Human Services Publication No. (SMA) 06-4180; Published 9/2006. 2006 [cited 2006 October 3]; Available at

Cicero TJ, Lynskey MT, Todorov A, et al.: Comorbid psychopathology and pain in males and females in treatment for opioid analgesic abuse. Pain. In review.

American Psychiatric Association.: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.

Cicero TJ, Adams EH, Geller A, et al.: A postmarketing surveillance program to monitor Ultram (tramadol hydrochloride) abuse in the United States. Drug Alcohol Depend. 1999; 57(1): 7-22.

Cicero TJ, Inciardi JA, Adams EH, et al.: Rates of abuse of tramadol remain unchanged with the introduction of new branded and generic products: Results of an abuse monitoring system, 1994-2004. Pharmacoepidemiol Drug Saf. 2005; 14(12): 851-859.

Carrieri MP, Amass L, Lucas GM, et al.: Buprenorphine use: The international experience. Clin Infect Dis. 2006; 43 (Suppl 4): S197-S215.

Inciardi JA, Cicero TJ, Munoz A, et al.: The diversion of ultram, ultracet, and generic tramadol HCL. J Addict Dis. 2006; 25(2): 53-58.

Cicero TJ, Inciardi JA, Munoz A.: Trends in abuse of oxycontin and other opioid analgesics in the United States: 2002-2004. J Pain. 2005; 6(10): 662-672.

Fendrich M, Yun Soo Kim J.: Multiwave analysis of retest artifact in the National Longitudinal Survey of Youth drug use. Drug Alcohol Depend. 2001; 62(3): 239-253.

Senay EC.: Clinical experience with T’s and B’s. Drug Alcohol Depend. 1985; 14: 305-311.

Aquilino W.: Interview mode effects in surveys of drug and alcohol use: A field experiment. Public Opin Q. 1994; 58: 210-240.

Aquilino WW, Wright DL.: Substance use estimates from rdd and area probability samples: impact of differential screening methods and unit non-response. Public Opin Q. 1996; 60: 563-573.



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