Identifying Abuse and Diversion

Opioid diversion has become more of an issue in recent years due in part to increased availability, prescription fraud, and improper prescribing (DEA 2006). Diversion of buprenorphine, though a relatively small problem compared to other controlled substances, does occur. Research indicates that most people abuse buprenorphine in an effort to self-medicate or to manage an addiction rather than to get high (Foxhall 2005; Johnson 2008).

Patients most likely to abuse or divert buprenorphine include those with:

  • High-dose opioid use
  • History of legal problems
  • History of mental health problems
  • Personal history or family history of substance abuse
  • Poor family support

The following red flags may indicate that a buprenorphine patient is abusing or diverting prescriptions:

  • Drug-seeking behavior
  • Request for early refills
  • Lost prescriptions
  • Request for higher dose after period of stabilization
  • Compulsive drug use
  • Cravings

However, be aware of situations where these behaviors may be masking underlying health issues, eg: pain that is not being adequately treated (Katz, 2007).



Related Resources: 
Diversion and Abuse of Buprenorphine: A Brief Assessment of Emerging Indicators
Description: 
This report by SAMHSA addresses the issues of buprenorphine diversion and abuse of which have developed in recent years. The report gives a summary of the findings on diversion and abuse and recommendations for the future.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Emerging Clinical Challenges in Prescribing Buprenorphine
Description: 
This presentation examines issues that have arisen in buprenorphine treatment to date and suggests measures that can be taken to address these issues going forward.
Source: 
Elinore McCance-Katz, M.D., Ph.D. (presentation from SAMHSA 2008 Buprenorphine Summit)
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Subutex® and Suboxone®: How Much Is Prescribed vs. Abuse/Diversion Reports
Description: 
This presentation discusses diversion of Subutex® and Suboxone® both in a general sense and in the specific case of the RADARS system, a nonprofit governmental program through the Rocky Mountain Poison and Drug Center.
Source: 
Nabarun Dasgupta, MPH (presentation from SAMHSA 2008 Buprenorphine Summit)
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RADARS® System
Description: 
RADARS®, the Researched Abuse, Diversion, and Addiction-Related Surveillance System, tracks prescription drug abuse, misuse and diversion throughout the United States. It is a nonprofit operation of the Rocky Mountain Poison and Drug Center, a division of Denver Health.
Source: 
RADARS®
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