Scope of, Motivations for, and Outcomes Associated with Buprenorphine Diversion in the United States: A Scoping Review

Abstract

Background

Expanding access to medications to treat opioid use disorder (OUD), such as buprenorphine, is an evidence-based response to the mounting drug overdose crisis. However, concerns about buprenorphine diversion persist and contribute to limited access.

Methods

To inform decisions about expanding access, a scoping review was conducted on publications describing the scope of, motivations for, and outcomes associated with diverted buprenorphine in the U.S.

Results

In the 57 included studies, definitions for diversion were inconsistent. Most studied use of illicitly-obtained buprenorphine. Across studies, the scope of buprenorphine diversion ranged from 0% to 100%, varying by sample type and recall period. Among samples of people receiving buprenorphine for OUD treatment, diversion peaked at 4.8%. Motivations for using diverted buprenorphine were self-treatment, management of drug use, to get high, and when drug of choice was unavailable. Associated outcomes examined trended toward positive or neutral, including improved attitudes toward and retention in MOUD.

Conclusions

Despite inconsistent definitions of diversion, studies reported a low scope of diversion among people receiving MOUD, with inability to access treatment as a motivating factor for using diverted buprenorphine, and increased retention in MOUD as an outcome associated with use of diverted buprenorphine. Future research should explore reasons for diverted buprenorphine use in the context of expanded treatment availability to address persistent barriers to evidence-based treatment for OUD.

Keywords:

• Buprenorphine
• diversion
• drug treatment
• medications for opioid use disorder
• drug policy
• scoping review

Disclosure statement

No potential conflict of interest was reported by the authors.

CRediT author statement

Stephanie Rubel: conceptualization, formal analysis, writing- original draft, visualization; Jessica Wolff: conceptualization, formal analysis, writing- review & editing; Michael Cavelski: formal analysis, writing- review & editing; Sasha Mital: conceptualization, methodology, formal analysis, writing- original draft, visualization

Notes

1 Studies rarely reported mutually exclusive motivations.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.