Three Complementary Approaches to Characterize Buprenorphine Misuse

ABSTRACT

Background: In France, buprenorphine has been available for opioid maintenance therapy since 1996 and since then its misuse has been continuously evaluated by the French health authorities. Objectives: To characterize buprenorphine misuse in Languedoc-Roussillon (LR) region, using three different approaches. Methods: Three different data sources were analyzed : (i) spontaneous reports (NotS) of buprenorphine misuse or dependence, (ii) a specific periodic survey from specialized care centers (OPPIDUM) over 11 years (2002–2012) and (iii) a drug reimbursement database (DRB). Results: A total of 209 spontaneous reports were collected. The main type of buprenorphine misuse was use by an unintended route of administration. The main complications notified were directly related to the injection of buprenorphine. NotS enabled the collection of data about severe clinical complications or new diversion phenomenon. The OPPIDUM LR survey revealed a decrease in the buprenorphine misuse indicator through the study period. The DRB analysis identified one subgroup of patients with a buprenorphine deviant behavior, characterized by a significantly greater number of dispensing episodes, pharmacies, prescribers, daily dose and switch between buprenorphine forms (princeps and generic). The DRB analysis provides data on buprenorphine diversion in the context of outpatients care. Conclusion: The three complementary approaches allowed us to characterize buprenorphine misuse in LR area. The three approaches are complementary because each data source provides different types of information.

KEYWORDS:

• Buprenorphine
• prescription drug misuse
• prescription drug diversion
• postmarketing product surveillance
• heroin dependence

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.