The Emerging Buprenorphine Epidemic in the United States

Abstract

The authors sampled for expanded drug testing of 1,061 urine specimens collected by Maryland Division of Parole and Probation staff. They found an increase in the percentage of individuals testing positive for buprenorphine and found that these specimens often contained other drugs, suggesting misuse. Subsequent interviews with 15 probationers and parolees in Baltimore, Maryland, showed wide-scale availability of buprenorphine on the street and in prisons. Medical examiners and drug testing programs should immediately initiate routine testing for buprenorphine to track a possible outbreak of buprenorphine diversion and misuse. Physician education programs should redouble their efforts to teach strategies to deter diversion and misuse of the drug.

KEYWORDS:

• Buprenorphine misuse
• epidemic
• public health intervention
• drug testing

Acknowledgments

The Maryland Governor's Office of Crime Control and Prevention funded part of this project under grant number BJAG-2005-1080. All points of view in this document are those of the authors and do not necessarily represent the official position of any State or Federal agency. The findings in this report represent those of the authors and do not reflect the views of the Department of Public Safety and Correctional Services or its constituent agencies.

Notes

One of the three laboratories tested submissions from only one site and analyzed their 20 specimens for only 4 drugs, omitting PCP from their panel.

In 2008, we oversampled DPP+ specimens submitted to the Guilford laboratory from the five sites that had the most buprenorphine-positive specimens (10% or greater) in the 2005 study. We collected 25 DPP+ specimens instead of the 15 DPP+ specimens collected in the other sites. Therefore, it was possible that the overall increase in buprenorphine-positives from the Guilford laboratory in the 2008 study was caused by the 10 additional DPP+ specimens we had collected from each of these five sites. We reanalyzed the Guilford laboratory data by weighting the 25 DPP+ specimens from the five sites to count as 15 DPP+ specimens. Our weighted estimate for buprenorphine-positive specimens from the Guilford laboratory changed slightly, from 13% to 12%.