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Research Summary

People with Injection Drug Use Primarily Take Diverted Buprenorphine to Avoid Withdrawal

As opioid agonist treatment with buprenorphine has expanded, so too have concerns over diversion and illicit use. Participants in a Baltimore cohort of 2942 people with current and former injection drug use (IDU) were asked about their illicit use of buprenorphine.

  • Overall, 74% of participants reported seeing buprenorphine sold on the street, 45% reported ever being prescribed it or taking it illicitly; 16% in the past 3 months and 11% in the prior 30 days.
  • The majority (56%) of those who reported having ever taken buprenorphine stated that their usual source was a doctor; 23% reported obtaining it from the street, and 13% from a friend.
  • Only 9% reported recently taking street-obtained buprenorphine; on multivariable analysis, this was associated with active heroin (odds ratio [OR], 6.6) and injection drug use (OR, 3.1).
  • Among those who reported ever taking illicit buprenorphine, 72% of participants reported having taken it to manage withdrawal symptoms and over half of them reported doing so while waiting for treatment.


This study shows that people with IDU who take diverted buprenorphine primarily do so to prevent withdrawal symptoms. Moreover, it indicates that despite the increased availability of opioid agonist treatment with the introduction of sublingual buprenorphine, there is still an unmet need for treatment. The extent to which diverted buprenorphine is taken by other populations and for what reasons are concerns that were not addressed by this study. Darius A. Rastegar, MD


Genberg BL, Gillespie M, Shuster CR, et al. Prevalence and correlates of street-obtained buprenorphine use among current and former injectors in Baltimore, Maryland. Addict Behav. 2013;38(12):2868–2873.