Hostname: page-component-5c6d5d7d68-qks25 Total loading time: 0 Render date: 2024-08-14T06:26:03.306Z Has data issue: false hasContentIssue false

Buprenorphine MAT as an Imperfect Fix

Published online by Cambridge University Press:  01 January 2021

Extract

Expanding buprenorphine access in the United States requires evidence-based decision-making that considers both the drug's potential dangers and its potential benefits. Risks associated with buprenorphine misuse and diversion highlight the need for careful, ongoing evaluation during each stage of increased access.

Type
Symposium Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lopez, G., “There’s a Highly Successful Treatment for Opioid Addiction. But Stigma is Holding it Back,” Vox, July 20, 2017, available at <https://www.vox.com/science-and-health/2017/7/20/15937896/medication-assisted-treatment-methadone-buprenorphine-naltrexone> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
Pierce, M. et al. “Impact of Treatment for Opioid Dependence on Fatal Drug-Related Poisoning: A National Cohort Study in England,” Addiction 111, no. 2 (2016): 298308.CrossRefGoogle Scholar
See Lopez, supra note 1.Google Scholar
See e.g. “It’s Time for the U.S. to Decriminalize Drug Use and Possession,” Drug Policy Alliance 2017): 1-38, at 12, available at <http://www.drugpolicy.org/sites/default/files/documents/Drug-Policy-Alliance-Time-to-Decriminalize-Report-July-2017.pdf> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
See e.g. Schulte, F. and Donovan, D., “The ‘Bupe’ Fix,” Baltimore Sun, December 16, 2007, available at <http://www.baltimoresun.com/bal-te.bupe16dec16-story.html> (last visited April 13, 2018) (“Though he described Suboxone as a ‘good drug’ for treating addicts, [RADARS executive director Richard] Dart said that buprenorphine enthusiasts tend to minimize abuse.”)+(last+visited+April+13,+2018)+(“Though+he+described+Suboxone+as+a+‘good+drug’+for+treating+addicts,+[RADARS+executive+director+Richard]+Dart+said+that+buprenorphine+enthusiasts+tend+to+minimize+abuse.”)>Google Scholar
“About Us,” The National Alliance of Advocates for Buprenorphine Treatment, available at <https://www.naabt.org/about_us.cfm> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
Sontag, D., “Addiction Treatment With a Dark Side,” New York Times, November 16, 2013, available at <http://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-andon-the-street-bupe-can-be-savior-or-menace.html> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
“Statement from FDA Commissioner Scott Gottlieb, M.D., on the Agency’s Continued Efforts to Promote the Safe Adoption of Medication-Assisted Treatment for Opioid addiction,” U.S. Food and Drug Administration, September, 20, 2017, at <https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm576752.htm> (last visited April 13, 2018) (committing to “promoting more widespread, safe adoption of MAT as a way to help more people overcome addiction.”)+(last+visited+April+13,+2018)+(committing+to+“promoting+more+widespread,+safe+adoption+of+MAT+as+a+way+to+help+more+people+overcome+addiction.”)>Google Scholar
See e.g. Szalavitz, M., “What Trump’s National Opioid Emergency Should Look Like,” Vice, August 14, 2017, at <https://www.vice.com/en_us/article/qvv8nw/what-trumps-national-opioid-emergency-should-look-like> (last visited April 13, 2018); M. Rigg, “FDA Commissioner Scott Gottlieb Goes to Bat For Evidence-Based Opioid Policies,” Reason: Hit & Run Blog, October 27, 2017, available at <http://reason.com/blog/2017/10/27/fda-commissioner-scott-gottlieb-goes-to> (last visited April 13, 2018).+(last+visited+April+13,+2018);+M.+Rigg,+“FDA+Commissioner+Scott+Gottlieb+Goes+to+Bat+For+Evidence-Based+Opioid+Policies,”+Reason:+Hit+&+Run+Blog,+October+27,+2017,+available+at++(last+visited+April+13,+2018).>Google Scholar
Levin, Senator, speaking on S231, 109th Congress, 1st Session, Congressional Record 151 (Jan. 24, 2005): S231-S232; see also Sontag, supra note 7.Google Scholar
See e.g. “Fighting Back: The Way Out,” Highlands Current, October 13, 2017, available at <http://highlandscurrent.com/2017/10/13/fighting-back-the-way-out> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
Abadinsky, H., Drug Use and Abuse: A Comprehensive Introduction (Boston: Cengage Learning, 2017): at 205.Google Scholar
Jaffe, J. H. and O’Keeffe, C., “From Morphine Clinics to Buprenorphine: Regulating opioid agonist treatment of addiction in the United States,” Drug and Alcohol Dependence 70, no. 2 supplement (2003): S3-S11, at S4; H. Joseph, S. Stancliff, and J. Langrod, “Methadone Maintenance Treatment (MMT): A Review of Historical and Clinical Issues,” Mount Sinai Journal of Medicine 67, no. 5-6 (2000): 347-365, at 348.Google Scholar
Quinones, S., Dreamland: The True Tale of America’s Opiate Epidemic (New York: Bloomsbury Books, 2015): at 63.Google Scholar
Id. at 78.Google Scholar
Jaffe and O’Keefe, supra note 13 at S4.Google Scholar
Adabinsky, supra note 12.Google Scholar
Vorenberg, J., “The War on Crime: The First Five Years,” Atlantic, May 1972, available at <https://www.theatlantic.com/past/docs/politics/crime/crimewar.htm> (last visited April 13, 2018). See also Adabinsky, supra note 12.+(last+visited+April+13,+2018).+See+also+Adabinsky,+supra+note+12.>Google Scholar
Vorenberg supra note 19.Google Scholar
Institute of Medicine, Federal Regulation of Methadone Treatment, (Washington, DC: The National Academies Press, 1995): at 95, available at <https://doi.org/10.17226/4899> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
Jaffe and O’Keefe supra note 13 at S5.Google Scholar
See Center for Substance Abuse Treatment, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, (Rockville, MD), Substance Abuse and Mental Health Services Administration (US), (2005): at 78, available at <https://www.ncbi.nlm.nih.gov/books/NBK64152> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
Id. See also 42 C.F.R., § 8.12 (2015).Google Scholar
See e.g. Rosenbaum, M. and Murphy, S., “Not the Picture of Health: Women on Methadone,” Journal of Psychoactive Drugs 19, no. 2 (1987): 217-226, at 217.Google Scholar
Fischer, B., Rehm, J., Kim, G., and Kirst, M., “Eyes Wide Shut? – A Conceptual and Empirical Critique of Methadone Maintenance Treatment,” European Addiction Research 11, no. 1 (2005): 1-14, at 4.Google Scholar
See Manchikanti, L., “Prescription Drug Abuse: What is Being Done to Address this New Drug Epidemic? Testimony Before the Subcommittee on Criminal Justice, Drug Policy and Human Resources,” Health Policy Review 9, no. 4 (2006): 287-321, at 287, 300; see also M. Madden and S. Shapiro, “The Methadone Epidemic: Methadone-Related Deaths on the Rise in Vermont,” American Journal of Forensic Medicine 32, no. 2 (2011): 131-135, at 134.Google Scholar
Faul, M., Bohm, M., and Alexander, C., “Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies — United States, 2007–2014,” Morbidity and Mortality Weekly Report 2017 66, no. 12 (2017): 320323, available at <http://dx.doi.org/10.15585/mmwr.mm6612a2> (last visited April 13, 2018).CrossRefGoogle Scholar
Institute of Medicine, supra note 21 at 10.Google Scholar
Madden and Shapiro, supra note 30.Google Scholar
See Khanna, I. K. and Pillarisetti, S., “Buprenorphine – an Attractive Opioid with Underutilized Potential in Treatment of Chronic Pain,” Journal of Pain Research 8 (2015): 859870, 864, available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675640> (last visited April 13, 2018).Google Scholar
“Buprenorphine Drug Label,” U.S. Food & Drug Admin. (2002), available at <https://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM191529.pdf> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
Lyseng-Williamson, K. A., “Buprenorphine/Naloxone Sublingual Tablet (Zubsolv®): A Guide to its use in the Maintenance Treatment of Opioid Dependence in the USA,” Drugs & Therapy Perspectives 29, no. 11 (2013): 336-341.Google Scholar
“Buprenorphine Training for Physicians,” Substance Abuse and Mental Health Services Administration, July 7, 2016, available at <https://www.samhsa.gov/medication-assisted-treatment/training-resources/buprenorphine-physician-training> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
21 U.S.C. § 823 (2018); Qualify for Nurse Practitioners (NPs) and Physician Assistants (PAs) Waiver, Substance Abuse and Mental Health Services Administration, January 18, 2018, available at <https://www.samhsa.gov/programs-campaigns/medication-assisted-treatment/training-materials-resources/qualify-np-pa-waivers> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
See Guevremont, N., Barnes, M., and Haupt, C., “Physician Autonomy and the Opioid Crisis,” The Journal of Law, Medicine & Ethics 46, no. 2 (2018): 203-219.CrossRefGoogle Scholar
Knudsen, H. K., Havens, J. R., Lofwall, M. R., Studts, J. L., and Walsh, S. L., “Buprenorphine Physician Supply: Relationship with State-Level Prescription Opioid Mortality,” Drug and Alcohol Dependence 173 (2017): S55-S64, at S56, available at <https://doi.org/10.1016/j.drugalcdep.2016.08.642> (last visited April 13, 2018).Google Scholar
“Buprenorphine,” Substance Abuse and Mental Health Services Administration, May 31, 2016, available at <https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine> (last visited April 13, 2018).+(last+visited+April+13,+2018).>Google Scholar
Walsh, S. L., Preston, K. L., Stitzer, M. L., Cone, E. J., and Bigelow, G. E., “Clinical Pharmacology of Buprenorphine: Ceiling Effects at High Doses.” Clinical Pharmacology & Therapeutics 55, no. 5 (1994): 569580, at 579.Google Scholar
“The Facts About Buprenorphine for Treatment of Opioid Addiction,” Substance Abuse and Mental Health Services Administration (2011), available at <https://store.samhsa.gov/shin/content/SMA09-4442/SMA09-4442.pdf> (last visited April 17, 2018).+(last+visited+April+17,+2018).>Google Scholar
“Buprenorphine,” Substance Abuse and Mental Health Services Administration, May 31, 2016, available at <https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine> (last visited April 17, 2018); see also “Annual Report 2005,” European Monitoring Centre for Drugs and Drug Addiction (2005), at 42, available at <http://www.emcdda.europa.eu/system/files/publications/365/sel2005_3-en_69710.pdf_en> (last visited April 17, 2018).+(last+visited+April+17,+2018);+see+also+“Annual+Report+2005,”+European+Monitoring+Centre+for+Drugs+and+Drug+Addiction+(2005),+at+42,+available+at++(last+visited+April+17,+2018).>Google Scholar
See supra notes 4-9.Google Scholar
“Buprenorphine,” U.S. Drug Enforcement Administration (2013) available at <https://www.deadiversion.usdoj.gov/drug_chem_info/buprenorphine.pdf> (last visited April 17, 2018).+(last+visited+April+17,+2018).>Google Scholar
“United Kingdom: Country Report 2017,” European Monitoring Centre for Drugs and Drug Addiction (2017), at 13 available at <http://www.emcdda.europa.eu/system/files/publications/4529/TD0116925ENN.pdf_en>(last visited April 17, 2018).(last+visited+April+17,+2018).>Google Scholar
Lofwall, M.R. and Walsh, S., “A Review of Buprenorphine Diversion and Misuse: The Current Evidence Base and Experiences from Around the World,” Journal of Addictive Medicine 8, no. 5 (2014): 315-326, at 322.CrossRefGoogle Scholar
Id. See also Ahmadi, J., Ahmadi, K., and Ohaeri, J., “Controlled, Randomized Trial in Maintenance Treatment of Intravenous Buprenorphine Dependence with Naltrexone, Methadone or Buprenorphine: A Novel Study,” European Journal of Clinical Investigation 33, no. 9 (2003): 824829, at 825.Google Scholar
See Sontag, supra note 7.Google Scholar
Nigam, A. et al., “Naloxone-Induced Withdrawal in Patients with Buprenorphine Dependence,” Addiction 89, no. 3 (1994): 317-320, at 317-318; Ahmadi, Ahmadi and Ohaeri, supra note 51, at 824; Substance Abuse and Mental Health Services Administration, supra note 45.Google Scholar
Uosukainen, H. et al., “Twelve-Year Trend in Treatment Seeking for Buprenorphine Abuse in Finland,” Drug and Alcohol Dependence 127, no. 1-3 (2013) 207-214, at 210-211.CrossRefGoogle Scholar
Genis, D., “This Anti-Heroin Drug Is Now King of the Jail-house Drug Trade,” Daily Beast, July 17, 2014, available at <https://www.thedailybeast.com/this-anti-heroin-drug-isnow-king-of-the-jailhouse-drug-trade> (last visited April 17, 2018).+(last+visited+April+17,+2018).>Google Scholar
Reckitt Benckiser Pharmaceuticals Inc., “Safety Concerns Regarding Buprenorphine For Opioid Dependence,” September 25, 2012, at 5 available at <https://www.naabt.org/documents/Reckitt_Benckiser_Pharmaceuticals_Inc_2012_FDA_Citizen_Petition.pdf> (last visited April 17, 2018).+(last+visited+April+17,+2018).>Google Scholar
Food and Drug Administration, “Sublingual Tablets, Equivalent 2 Milligrams Base and Equivalent 8 Milli-grams Base, Were Not Withdrawn From Sale for Reasons of Safety or Effectiveness,” 80 Federal Register 8088 (2015), available at <https://www.federalregister.gov/documents/2015/02/13/2015-03001/determination-that-subutexbuprenorphine-hydrochloride-sublingual-tablets-equivalent-2-milligrams>; see also Reckitt Benckiser, supra note 56.;+see+also+Reckitt+Benckiser,+supra+note+56.>Google Scholar
“Naloxone,” Substance Abuse and Mental Health Services Administration, March 3, 2016, available at <https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone> (last visited April 17, 2018).+(last+visited+April+17,+2018).>Google Scholar
See Substance Abuse and Mental Health Services Administration, supra note 46.Google Scholar
Id. See also Simojoki, K., Vorma, H., and Alho, H., “A Retrospective Evaluation of Patients Switched from Buprenorphine (Subutex) to the Buprenorphine/Naloxone Combination (Suboxone),” Substance Abuse Treatment, Prevention & Policy (2008): 3-16, at 3; “Suboxone — INN Buprenorphine/Naloxone,” European Medicines Agency (2011) at 4, available at <http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000697/WC500058505.pdf> (last visited April 17, 2018); Substance Abuse and Mental Health Services Administration, supra note 45, at 4; D. Jacobs, “I’m a Doctor who wants to Treat Addiction, but the Rules won’t Let Me,” Washington Post, January 14, 2017, available at <https://www.washington-post.com/national/health-science/im-a-doctor-who-wants-to-treat-addiction-but-the-rules-wont-let-me/2017/01/13/faaa6ee4-d2b0-11e6-9cb0-54ab630851e8_story.html> (last visited April 17, 2018).Google Scholar
Lofwall and Walsh, supra note 50.Google Scholar
See Vicknasingam, B., Mazlanb, M., Schottenfeld, R. S., and Chawarski, M.C., “Injection of Buprenorphine and Buprenorphine/Naloxone Tablets in Malaysia,” Drug and Alcohol Dependence 111, no. 1-2 (2010): 4449; at 45; H. Alho, D. Sinclair, E. Vuori, and A. Holopainen, “Abuse Liability of Buprenorphine–Naloxone Tablets in Untreated IV Drug Users,” Drug and Alcohol Dependence 88, no. 1 (2007): 75–78, at 77.CrossRefGoogle Scholar
See Vicknasingam, Mazlanb, Schottenfeld, and Chawarski supra note 62.Google Scholar
Dr. Marek Chawarski (Associate Professor of Psychiatry and of Emergency Medicine, Yale School of Medicine), interview with author, October 26, 2017; Id at 44.Google Scholar
See Vicknasingam, Mazlanb, Schottenfeld, and Chawarski supra note 62.Google Scholar
Simojoki, K. and Alho, H., “A Five-Year Follow-up of Buprenorphine Abuse Potential,” Journal of Alcohol and Drug Dependence 1, no. 2 (2013): 1-6, at 1, available at <https://www.omicsonline.org/open-access/a-five-year-follow-upof-buprenorphine-abuse-potential-2329-6488.1000111.php?aid=11701> (last visited May 25, 2018).Google Scholar
“European Drug Report: Trends and Developments,” European Monitoring Centre for Drugs and Drug Addiction (2016), at 49 available at <http://www.emcdda.europa.eu/system/files/publications/2637/TDAT16001ENN.pdf> (last visited April 17, 2018).+(last+visited+April+17,+2018).>Google Scholar
Yokell, M. A., Zaller, N. D., Green, T. C., and Rich, J. D., “Buprenorphine and Buprenorphine/Naloxone Diversion, Misuse, and Illicit Use: An International Review,” Current Drug Abuse Reviews 4, no. 1 (2011): 2841, at 33 available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154701> (last visited April 17, 2018).Google Scholar
Simojoki and Alho, supra note 66.Google Scholar
Partanen, A. and Mäki, J., “Buprenorphine More Common as a Problem Drug in Finland,” Nordisk Alkohol- & Narkotikatidskrift 21 (2004): 156-161, at 159, available at <http://journals.sagepub.com/doi/pdf/10.1177/145507250402101s17> (last visited May 25, 2018).Google Scholar
Pirona, A., Guarita, B., Montanari, L., and Noor, A., “Ageing and Addiction: Challenges for Treatment Systems,” European Monitoring Centre for Drugs and Drug Addiction, available at <http://www.emcdda.europa.eu/system/files/publications/3435/05_LXAddictions_AP_ageing_FINAL.pdf> (last accessed Jan. 14, 2018).+(last+accessed+Jan.+14,+2018).>Google Scholar
See European Monitoring Centre for Drugs and Drug Addiction, supra note 46.Google Scholar
Williams, S. T., “What’s it Really like to Withdraw from Heroin and Painkillers?” MinnPost, February 14, 2014, available at <https://www.minnpost.com/mental-health-addiction/2014/02/whats-it-really-withdraw-heroin-andpainkillers> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Fite, J., “Musings: ‘India’s New Drug Subculture,’” National Geographic, November, 18, 2013, available at <http://proof.nationalgeographic.com/2013/11/18/musings-indias-new-drug-subculture> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
See Solomon, S. S. et al., “The Profile of Injection Drug Users in Chennai, India: Identification of Risk Behaviours and Implications for Interventions,” Substance Use & Misuse 45, no. 3 (2010): 354367, available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924430> (last visited April 18, 2018).Google Scholar
“Intelligence Bulletin: Buprenorphine: Potential for Abuse,” National Drug Intelligence Center September 2004, available at <https://www.justice.gov/archive/ndic/pubs10/10123/index.htm> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Casati, A., Sedefov, R., and Pfeiffer-Gerschel, T., “Misuse of Medicines in the European Union: A Systematic Review of the Literature,” European Addiction Research 18 (2012): 228245, at 241.Google Scholar
See Substance Abuse and Mental Health Services Administration, supra note 46Google Scholar
Vicknasingam, Mazlanb, Schottenfeld, and Chawarski supra note 62 at 47.Google Scholar
See European Monitoring Centre for Drugs and Drug Addiction, supra note 67, at 67.Google Scholar
European Monitoring Centre for Drugs and Drug Addiction, supra note 46, at 42-43.Google Scholar
Walsh, Preston, Stitzer, Cone, and Bigelow, supra note 44 at 579.Google Scholar
Saxon, A. J., Yih-Ing, H., Woody, G., and Ling, W., “Medication-Assisted Treatment for Opioid Addiction: Methadone and Buprenorphine,” Journal Food Drug Analysis 2, no. 4 (2014): S69S72, at S70.Google Scholar
Kosten, T. R. and George, T. P., “The Neurobiology of Opioid Dependence: Implications for Treatment,” Science & Practice Perspectives 1, no. 1 (2002): 1320, at 15, available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054> (last visited April 18, 2018).Google Scholar
See e.g. Benyamin, R., Trescot, A. M., and Datta, S., “Opioid Complications and Side Effects,” Pain Physician 11, no. 2, supp (2008): S105-S120, at S115, available at <http://www.thblack.com/links/RSD/PainPhysician2008_11_S105_complications%26side-effects.pdf> (last visited April 18, 2018).Google Scholar
Seelye, K. Q., “Heroin Epidemic Is Yielding to a Deadlier Cousin: Fentanyl,” New York Times, March 25, 2016, available at <https://www.nytimes.com/2016/03/26/us/heroin-fentanyl.html> (last visited April 18, 2018); see also S. Birr, “Heroin Addicts Are Seeking Out Fatal Batches To Score The ‘Most Potent Dose,’” Daily Caller, April 5, 2017, available at <http://dailycaller.com/2017/04/05/heroin-addicts-are-seeking-out-fatal-batches-to-score-the-most-potent-dose> (last visited April 18, 2018).+(last+visited+April+18,+2018);+see+also+S.+Birr,+“Heroin+Addicts+Are+Seeking+Out+Fatal+Batches+To+Score+The+‘Most+Potent+Dose,’”+Daily+Caller,+April+5,+2017,+available+at++(last+visited+April+18,+2018).>Google Scholar
Seelye, supra note 88.Google Scholar
European Monitoring Centre for Drugs and Drug Addiction, supra note 46, at 48.Google Scholar
Ferrant, O. et al., “Fatal Poisoning Due to Snorting Buprenorphine and Alcohol Consumption,” Forensic Science International 204, no. 1-3 (2011): e8-e11, at e10.Google Scholar
Collins, R. L., Ellickson, P. L., and Bell, R. M., “Simultaneous Polydrug Use Among Teens: Prevalence And Predictors,” Journal of Substance Abuse 10, no. 3 (1999): 233-253, at 233-234.CrossRefGoogle Scholar
Cherkis, J., “Dying To Be Free,” Huffington Post, January 28, 2015, available at <http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Harris, S., “To Be Free and Normal: Addiction, Governance, and the Therapeutics of Buprenorphine,” Medical Anthropology Quarterly 29, no. 4 (2015): 512530, at 521.Google Scholar
Id., see also Genis, supra note 55.Google Scholar
Cushman, P. Jr., “Alcohol and Opioids: Possible Interactions of Clinical Importance,” Advances Alcohol & Substance Abuse 6, no. 3 (1987): 33-46, at 41.Google Scholar
“Suboxone Label,” U.S. Food and Drug Administration, (December 2011) at 19, available at <https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020733s007s008lbl.pdf> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Substance Abuse and Mental Health Services Administration, supra note 46.Google Scholar
“Suboxone (buprenorphine HCl and naloxone HCl dehydrate sublingual tablets) and Subutex (buprenorphine HCl sublingual tablets),” US Food and Drug Administration, available at <http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM191529.pdf> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Varma, S., Balachander, S., and Basu, D., “Buprenorphine-Induced Psychotic Symptoms: A Case Report,” The Primary Care Companion for CNS Disorders 15, no. 4 (2013).Google Scholar
See “Co-occurring Disorders,” Substance Abuse and Mental Health Services Administration, March 8, 2016, available at <https://www.samhsa.gov/disorders/co-occurring> (last visited April 18, 2018), Center for Substance Abuse Treatment, supra note 25 at Chapter 12; R. K. Brooner, V. L. King, M. Kidorf, C. W. Schmidt, and G. E. Bigelow, “Psychiatric and Substance Use Comorbidity Among Treatment-Seeking Opioid Abusers,” Archives of General Psychiatry 54, no. 1 (1997): 7180, at 71.+(last+visited+April+18,+2018),+Center+for+Substance+Abuse+Treatment,+supra+note+25+at+Chapter+12;+R.+K.+Brooner,+V.+L.+King,+M.+Kidorf,+C.+W.+Schmidt,+and+G.+E.+Bigelow,+“Psychiatric+and+Substance+Use+Comorbidity+Among+Treatment-Seeking+Opioid+Abusers,”+Archives+of+General+Psychiatry+54,+no.+1+(1997):+71–80,+at+71.>Google Scholar
European Monitoring Centre for Drugs and Drug Addiction, supra note 46, at 38; Soyka, M., Hock, B., Kagerer, S. et al., “Less Impairment on one Portion of a Driving-Relevant Psychomotor Battery in Buprenorphine-Maintained than in Methadone Maintained Patients,” Journal of Clinical Psycho-pharmacology 25, no. 5 (2005): 490-493, at 493.Google Scholar
See e.g. Benyamin, Trescot, and Datta, supra note 87 at S115.Google Scholar
See discussion supra at note 53.Google Scholar
Allen, J. D., Casavant, M. J., Spiller, H. A. et al., “Prescription Opioid Exposures Among Children and Adolescents in the United States: 2000–2015,” Pediatrics 139, no. 4 (2017): 1-10, available at <http://pediatrics.aappublications.org/content/early/2017/03/16/peds.2016-3382> (last visited April 18, 2018); C. Konijnenberg and A. Melinder, “Prenatal Exposure to Methadone and Buprenorphine: A Review of the Potential Effects on Cognitive Development,” Child Neuropsychology 17, no. 5 (2011): 495–519.Google Scholar
“Common Buprenorphine Side Effects,” The National Alliance of Advocates for Buprenorphine Treatment, available at <https://www.naabt.org/buprenorphine-side-effects.cfm> (last visited Jan. 12, 2018).+(last+visited+Jan.+12,+2018).>Google Scholar
Mattick, R. P., Ali, R., and White, J. M., “Buprenorphine versus Methadone Maintenance Therapy: A Randomized Double-Blind Trial with 405 Opioid-Dependent Patients,” Addiction 98, no. 4 (2003): 441452, at 441.Google Scholar
Gusovsky, D., “Americans Consume Vast Majority of the World’s Opioids,” CNBC, April 27, 2016, available at <https://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html> (last visited April 18, 2018); G. Lopez, “America Leads the World in Drug Overdose Deaths—by a Lot,” Vox, June 28, 2017, available at <https://www.vox.com/policy-and-politics/2017/6/28/15881246/drug-overdose-deaths-world> (last visited April 18, 2018).+(last+visited+April+18,+2018);+G.+Lopez,+“America+Leads+the+World+in+Drug+Overdose+Deaths—by+a+Lot,”+Vox,+June+28,+2017,+available+at++(last+visited+April+18,+2018).>Google Scholar
“World Drug Report 2016,” United Nations Office on Drugs and Crime, 2016, available at <https://www.unodc.org/wdr2016/interactive-map.html> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Katz, J., “Short Answers to Hard Questions About the Opioid Crisis,” New York Times, August 10, 2017, available at <https://www.nytimes.com/interactive/2017/08/03/upshot/opioid-drug-overdose-epidemic.html> (last visited April 18, 2018); Lopez, supra note 110.+(last+visited+April+18,+2018);+Lopez,+supra+note+110.>Google Scholar
United Nations Office on Drugs and Crime, Word Drug Report, (United Nations publication, Sales No. E.16.XI.7), at 8, available at <https://www.unodc.org/doc/wdr2016/WORLD_DRUG_REPORT_2016_web.pdf> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
CDC, “Rate of Patients with at Least one Opioid Prescription in the U.S. 2014 to 2016 (per 100 persons),” Statista - The Statistics Portal, available at <https://www.statista.com/statistics/752053/total-patient-rate-with-at-least-oneopioid-prescription-in-us> (last accessed January 22, 2018); CDC, “Number of patients with at least one opioid prescription in the U.S. 2016, by age,” Statistica, available at <https://www.statista.com/statistics/753093/total-patient-number-with-at-least-one-opioid-prescription-in-us-by-age> (accessed Jan. 22, 2018).+(last+accessed+January+22,+2018);+CDC,+“Number+of+patients+with+at+least+one+opioid+prescription+in+the+U.S.+2016,+by+age,”+Statistica,+available+at++(accessed+Jan.+22,+2018).>Google Scholar
SAMHSA, “Number of Individuals with a Heroin Dependence or Abuse During the Past Year in the United States from 2002 to 2016 (in 1,000),” Statistica, available at <https://www.statista.com/statistics/476276/number-of-individulas-with-a-heroin-dependence-us> (accessed Jan. 16, 2018).+(accessed+Jan.+16,+2018).>Google Scholar
Tice, P., “Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health,” Substance Abuse and Mental Health Administration, September 2017, at 21, available at <https://store.samhsa.gov/shin/content/SMA17-5044/SMA17-5044.pdf> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Sontag, supra at note 7.Google Scholar
See e.g. Pollini, R. A. et al., “Problematic Use of Prescription-Type Opioids prior to Heroin Use among Young Heroin Injectors,” Substance Abuse and Rehabilitation 2, no. 1 (2011): 173180, at 174, available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3536052> (last visited April 18, 2018); See also D. Leinwand Leger, “OxyContin a Gateway to Heroin for Upper-Income Addicts,” USA Today, April 15, 2016, available at <https://www.usatoday.com/story/news/nation/2013/04/15/heroin-crackdown-oxycodone-hydroco-done/1963123> (last visited April 18, 2018).Google Scholar
Sontag, supra at note 7.Google Scholar
Maxwell, J. C., “The Prescription Drug Epidemic in the United States: A Perfect Storm.” Drug & Alcohol Review 30, no. 3 (2011): 264-270, at 267.CrossRefGoogle Scholar
Tice, supra note 116 at 31.Google Scholar
Sontag, supra at note 7.Google Scholar
Minton, M., “Southwest Kansas treatment providers targeting opioid addiction,” Garden City Telegram, October 29, 2017, available at <http://www.gctelegram.com/news/20171029/southwest-kansas-treatment-providers-targeting-opioid-addiction> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Kranz, L., “Special Report: State Spends Millions on Addiction-Fighting Drug that is Diverted for Street Sale,” VT Digger, February 11, 2014, available at <https://vtdigger.org/2014/02/11/special-report-state-spends-millions-addiction-fighting-drug-diverted-street-sale> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
See Moleski, J. A., “Jeanette Ann Moleski, D.O.: Options matter in the Opioid Crisis,” Akron Beacon Journal, November 8, 2017, available at <https://www.ohio.com/akron/editorial/commentary/jeanette-ann-moleski-d-o-options-matter-inthe-opioid-crisis> (last visited Apri l18, 2018).+(last+visited+Apri+l18,+2018).>Google Scholar
Genis supra note 55.Google Scholar
Kranz, supra note 126.Google Scholar
Kodjak, A., “Maryland Switches Opioid Treatments, And Some Patients Cry Foul,” NPR, July 19, 2016, available at <https://www.npr.org/sections/health-shots/2016/07/19/486419277/maryland-switches-opioid-treatments-and-some-patients-cry-foul> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Ling, W. et al., “Buprenorphine Tapering Schedule and Illicit Opioid Use,” Addiction 104, no. 2 (2009): 256265, at 257.Google Scholar
Sigmon, S. C. et al., “A Randomized, Double-Blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers,” JAMA Psychiatry 70, no. 12 (2013): 13471354, at 1351.Google Scholar
Kelly, J. F. et al., “Prevalence and Pathways of Recovery from Drug and Alcohol Problems in the United States Population: Implications for Practice, Research, and Policy,” Drug and Alcohol Dependence 181 (2017): 162-169, at 168, available at <https://doi.org/10.1016/j.drugalcdep.2017.09.028> (last visited April 18, 2018).CrossRefGoogle Scholar
Fiellin, D. A., Renner, J. A. Jr., “Tapering Buprenorphine in Patients with Opioid Use Disorders,” PCSS-O, September 15, 2015, available at <https://pcss-o.org/event/tapering-buprenorphine-in-patients-with-opioid-use-disorders> (last accessed Feb. 6, 2018).+(last+accessed+Feb.+6,+2018).>Google Scholar
Id; “Tapering and Discontinuation of Patients from Buprenorphine,” Buppractice, available at <https://www.buppractice.com/node/12121> (last accessed Jan. 15, 2018); see also R. D. Blondell et al., “A Clinical Trial Comparing Tapering Doses of Buprenorphine With Steady Doses for Chronic Pain and Coexistent Opioid Addiction,” Journal of Addictive Medicine 4, no. 3 (2010): 140-146, at 140.+(last+accessed+Jan.+15,+2018);+see+also+R.+D.+Blondell+et+al.,+“A+Clinical+Trial+Comparing+Tapering+Doses+of+Buprenorphine+With+Steady+Doses+for+Chronic+Pain+and+Coexistent+Opioid+Addiction,”+Journal+of+Addictive+Medicine+4,+no.+3+(2010):+140-146,+at+140.>Google Scholar
Buppractice, supra note 139. See also Cassadonte, P. P., “Transfer from Methadone to Buprenorphine,” PCSS, August 9, 2006, at 3, available at <http://naabt.org/documents/PCSS_Meth-bupe-transfer.pdf> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
“Publications and Research,” Substance Abuse and Mental Health Services Administration, September 25, 2015, available at <https://www.samhsa.gov/medication-assisted-treatment/training-resources/publications> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Buppractice, supra note 139.Google Scholar
Genis supra note 55.Google Scholar
See e.g., Chaiyachati, K., and Hom, J., “Let’s Put Opioids For Treating Addiction On Equal Footing With Prescribing Opioids For Pain,” Health Affairs, May 10, 2016, available at <http://www.healthaffairs.org/do/10.1377/hblog20160510.054813/full> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
See Kranz, supra note 126.Google Scholar
Lofwall and Walsh, supra note 50 at 318.Google Scholar
“FDA Approves First Buprenorphine Implant for Treatment of Opioid Dependence,” U.S. Food and Drug Administration, May 26, 2016, available at <https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm503719.htm> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
“FDA Approves First Once-Monthly Buprenorphine Injection, a Medication-Assisted Treatment Option for Opioid use Disorder,” U.S. Food and Drug Administration, November 30, 2017, available at <https://www.fda.gov/NewsEvents/News-room/PressAnnouncements/ucm587312.htm> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
“Physical Activity is Important,” American Diabetes Association, December 27, 2016, available at <http://www.diabetes.org/food-and-fitness/fitness/physical-activity-is-important.html> (last visited April 18, 2018).+(last+visited+April+18,+2018).>Google Scholar
Interview with Dr. Chawarski, supra note 64; see also Leshner, A. I., “Science-Based Views of Drug Addiction and Its Treatment,” JAMA 282, no. 14 (1999): 1314-1316, at 1316. But see K. M. Carroll and R. Weiss, “The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review,” American Journal of Psychiatry 174, no. 8 (2017): 738-747, at 745, available at <https://www.ncbi.nlm.nih.gov/pubmed/27978771> (last visited April 18, 2018).CrossRefGoogle Scholar
“Statement from FDA Commissioner Scott Gottlieb,” supra note 8.Google Scholar