Use of buprenorphine and buprenorphine-naloxone via non-sublingual routes

  • Dr Adam Winstock, Sydney South West Area Health Service, Australia
  • Mr Toby Lea, Sydney South West Area Health Service, Australia
  • Buprenorphine, because of it sublingual formulation, is more susceptible to diversion that liquid methadone. While injection of buprenorphine has been widely reported, use by other routes has not (e.g., smoking; intranasal). It was in response to the potential for buprenorphine injecting that buprenorphine-naloxone (Suboxone) was developed and introduced. Not withstanding that buprenorphine use via any route is generally much safer than methadone, the implications of a more divertible although safer drug can still be significant. Not only are clients who regularly divert their buprenorphine not receiving medication in a way that will achieve optimal treatment outcomes, but treatment providers are in effect contributing to the street market of illegal drugs. Unchecked diversion damages the integrity of service provision and can result in negative perceptions of treatment services among funding bodies and the wider community. With the introduction of buprenorphine-naloxone, intended as a less desirable preparation of buprenorphine to inject, it is timely to consider the abuse potential of buprenorphine and buprenorphine-naloxone via non-injecting routes. Following discussions with clients reporting non-sublingual use of buprenorphine in gaol via the smoking route, we report on the findings of a large exploratory study of clients on methadone and buprenorphine regarding non-sublingual use of buprenorphine. The paper will report the frequency of using buprenorphine via the injecting, smoking and intranasal routes, the motivations and situations associated with use via these different routes as well as a discussion of how the drug effects are modified by route of administration. The implications for drug treatment in Australia will then be considered.