Diversion and Abuse of Buprenorphine: A Brief Assessment of ...

Hypothesis 6: Significant levels of buprenorphine diversion and abuse are occurring in
Vermont.
Relevant Information: Dr. Mandell first began to receive reports of buprenorphine abuse in early
2005. Because the reports were entirely anecdotal, he has used the limited data available to him –
as well phone consultations with prescribing physicians and other sources of information – to try
to clarify the situation.
Peter Lee of the Vermont SSA reported that some buprenorphine diversion and abuse is
occurring in Vermont. Mr. Lee confirmed that he has received anecdotal reports of
buprenorphine tablets being crushed and injected. However, he described this as “horizontal”
diversion within the addicted population – who rent pills for pill checks, for example, or sell part
of their supply of buprenorphine to a friend who cannot access treatment – rather than “vertical”
diversion into the general population.
An official of the Vermont Department of Corrections reported that buprenorphine was being
smuggled into the State’s correctional institutions, and said that the amount exceeded that of
methadone or oxycodone. He also described buprenorphine as easy to obtain on the street, as
compared to oxycodone, which he described as not widely used in Vermont (however, this
anecdotal report is not consistent with the DAWN medical examiner data).
Several other corrections officials suggested that buprenorphine was being smuggled into
correctional facilities to sell to inmates who wanted to “get high” or to help inmates withdraw
from heroin. Officials said some inmates who were addicted to heroin reported stockpiling
buprenorphine prior to their incarceration.
On the other hand, Gretchen Feussner of DEA’s Office of Diversion Control confirmed that the
DEA field office for Vermont had not received any reports of buprenorphine diversion.
The head of the Vermont State Police Laboratory reported that, in all of 2004 and 2005,
buprenorphine had been seized in only eight cases. In every case, the formulation involved was
Suboxone. Five seizures involved one tablet each, one seizure involved two tablets, and one
involved three tablets. Thus, the Vermont State Police laboratory does not consider diversion of
buprenorphine to be a significant problem at this time.
Multiple datasets were examined in an effort to determine whether and to what degree
buprenorphine was cited as either a primary or secondary drug of abuse by individuals entering
addiction treatment in Vermont. While SAMHSA’s Drug Abuse Warning Network (DAWN)
provides data on adverse events associated with a large number of drugs, no hospital emergency
departments in Vermont report to DAWN. Boston is the closest metropolitan area with
reporting hospitals. Interestingly, Boston also reports more emergency department visits related
to buprenorphine than any other metropolitan area in the DAWN system (Exhibit 7).
Results of the Vermont Case Study
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