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

system to coordinate care. Physicians who wish to participate in the incentive plan must agree to
work with a State­assigned Buprenorphine Coordinator. The Coordinator is to help the office
prepare for the treatment of opiate­addicted patients and to assure that every patient obtains all
recommended treatment services.
The SSA also is planning to develop a set of tools, including screening instruments and patient
contracts, for use by the Coordinators. Formal outcome measures will be used to measure the
effectiveness of the Coordinators and of the incentive program.
Recommendation: This may be an excellent model for other States.
Hypothesis 2: Buprenorphine is being widely used for the treatment of pain in Vermont.
Relevant Information: A sizeable number of Vermont physicians may be using Subutex and
Suboxone off­label for the treatment of pain. The outside experts consulted for this assessment
confirmed that many physicians prefer to use these oral formulation in treating pain patients rather
than Buprenex, which is labeled for pain, because Buprenex is available only in an injectable form.
The experts also suggested that some physicians may be using the Suboxone formulation in pain
management in an effort to avoid drug overdoses.
Analysts examined the distribution of buprenorphine within the State, as compared to the
distribution of physicians who hold waivers to prescribe the drug for office­based treatment of
opioid addiction (Exhibits 2a and 2b). The data not only showed wide variations in distribution of
buprenorphine from county to county, they also indicated that Suboxone and Subutex are being
dispensed in counties where there are no physicians who hold waivers to prescribe buprenorphine
for office­based treatment of opioid addiction.
Results of the Vermont Case Study
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