Illicit use and diversion of buprenorphine/naloxone among patients in buprenorphine/naloxone maintenance treatment in Istanbul, Turkey

Abstract

Background and aims. Besides noting the measures taken in Turkey against the buprenorphine/naloxone (BNX) combination to suppress the misuse of therapeutic opiates, a detailed study on the illicit use of BNX has become a compelling priority. The aim of this study is, in fact, to evaluate the extent of the illicit use and diversion of buprenorphine/naloxone (BNX) by patients in BNX maintenance treatment (BMT). Methods. 281 heroin-dependent patients were included in the study. These patients had consecutively attended the Alcohol and Drug Research Treatment and Training Center (AMATEM) polyclinic as BMT outpatients, and had reached the end of the stabilization phase at least 2 weeks after induction. Results. Of these 281 heroin-dependent subjects in BMT, 110 (39.1%) were considered as belonging to the group that had used illicit (i.e. unprescribed) BNX. This group presented higher current doses, a higher use of BNX before treatment, a shorter period of BNX treatment and a lower frequency of remission of drug use. There was no difference between the two groups in estimates of dose adequacy, receiving education for BNX use, having a legal problem and/or probation, using different routes for BNX other than the sublingual route of administration, or giving away BNX doses. Those in the group that did use illicit BNX showed higher percentages both for the more frequent use of BNX or higher doses of it, and its less frequent use or for lower doses, besides the more frequent use of other substances during BMT, compared with the group unaffected by illicit BNX. Conclusions. Most of the patients that used illicit BNX had done this before their monitored use of BNX and had used it to relieve withdrawal symptoms, which suggests that the main difficulty for those seeking illicit BNX in Istanbul is how to access treatment.