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: 
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.
Substance Abuse and Mental Health Services Administration (SAMHSA)
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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.
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