Steps Physicians Take to Reduce Diversion of Buprenorphine

Steps physicians report taking to reduce diversion of buprenorphine.
Yang A, Arfken CL, Johanson CE.
Am J Addict. 2013 May;22(3):184-7

This was a survey of over 2,000 buprenorphine waivered physicians.  Only 31% of those sent the survey completed it. Physicians were asked to select all steps they take to reduce inappropriate use or diversion of buprenorphine from a list of choices

Limit 30‐day prescriptions to complying patients	72.4%
Prescribe only the lowest effective daily dose	60.6%
Require regular urine screening or other drug screening	59.3%
Highly selective in accepting patients	47.1%
Coordinate services with counselors, pharmacists, and other physicians	46.5%
Require individual/group counseling unless not indicated	41.2%
Require more than monthly visits	34.2%
Random or frequent pill counts/medication recall	29.5%
At least one patient on greater than 16 mg of suboxone for maintenance	55.4%
Reassess patient when dose exceed 16 mg	24.6%
Ask family to observe pill taking	21.5%
Don’t use buprenorphine for maintenance	6.3%
Others	10.1%

Buprenorphine + Naloxone in Pregnancy

Buprenorphine + Naloxone in the Treatment of Opioid Dependence during Pregnancy-Initial Patient Care and Outcome Data.
Debelak K, Morrone WR, O'Grady KE, Jones HE.
Am J Addict. 2013 May;22(3):252-4

The authors report on 10 women treated with buprenorphine/nalolxone (Suboxone) rather than buprenorphine only (Subtex) in pregnancy.

Dosing was 8/2 up to 16/4 mg SL daily.  All urine drug tests negative at delivery.  This was not an especially high functioning or low risk group: none had completed education beyond high school (six had a high school degree), all but one had never married, none were employed full‐time, and one was currently involved with the criminal justice system.

There were two maternal medical complications: one case of pre‐eclampsia and one oligohydramnios. There was one c-section.

Neonates were, generally speaking, full‐term infants with normal birth parameters. One baby was born premature after PPROM, leading to an average gestational age 37.5w and average birth weight 6lbs 3 oz.

Four neonates were treated for NAS, needing on average 3.5 mg morphine over 6.9 treatment days.

The authors conclude: Findings do not raise obvious concerns for clinicians who might be considering treatment of opioid‐dependent pregnant women with buprenorphine þ naloxone.  They did note the need for further research