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Buprenorphine Misuse and Diversion

What is Buprenorphine?

Buprenorphine is a derivative of thebaine, an extract of opium. Buprenorphine is an opioid partial agonist, meaning it can activate the opioid receptors in the brain, but to a lesser degree than opioids such as heroin.

Partial agonist drugs like buprenorphine, butorphanol, and tramadol can be helpful for treating pain and can assist in treating opioid use disorder, as they can help minimize withdrawal symptoms. Buprenorphine has a ceiling effect, causing a plateau in the sedative effects, which helps protect the individual from negative respiratory and/or cardiovascular effects when taken as prescribed.

Buprenorphine has been used internationally for several years to assist people suffering from opioid dependency. Subutex, which is pure buprenorphine, is designed to be used in the initial stages of addiction treatment.1

Buprenorphine Misuse and Diversion

As the opioid crisis started growing, treatment drugs such as buprenorphine were being looked at for misuse and diversion. In 2014, the Food and Drug Administration required new safety labeling on prescribed opioids, indicating they are a Schedule III drug and warning of “risks of addiction, abuse, and misuse, which can lead to overdose and death.”3

According to the National Drug Intelligence Center, Suboxone (buprenorphine and naloxone)–because of its ceiling effect and ability to precipitate withdrawal systems if taken in high doses– is more susceptible to misuse by individuals who are addicted to low doses of opioids or individuals in the early stages of opioid addiction.1

Misuse may include mixing buprenorphine with other drugs, such as heroin or methamphetamine, for a more intense high. Buprenorphine misuse is extremely dangerous even though it is used in clinical settings. In those settings, buprenorphine is administered in small, specifically curated doses based on the patient’s substance use history.

Diversion of buprenorphine, or nonmedical use by people it is not prescribed for, is another potential risk for consideration. According to the Center for Disease Control’s (CDC) 2022 Clinical Practice guidelines for prescribing opioids, toxicology tests can assist clinicians in identifying when patients are not taking opioids prescribed for them, which may indicate diversion or other clinically important issues such as difficulties with adverse effects.3 Advanced specimen drug testing may be the link to identifying the misuse or diversion of buprenorphine.

USDTL Advanced Specimen Testing

As an innovative leader offering alcohol and other drug testing, we understand the importance of being able to test for drugs of concern when it is most feasible for your organization. We offer buprenorphine testing, along with testing for many other drugs of concern, in urine, nail, and hair specimens. Contact us at with any questions.