Table 9: Buprenorphine-Containing Products FDA-Approved for Opioid Use Disorder
Route(s) of Administration
Product Name
Available Strengths
Bunavail buccal films
• Buprenorphine 1 mg/naloxone 0.2 mg • Buprenorphine 2.1 mg/naloxone 0.3 mg • Buprenorphine 4.2 mg/naloxone 0.7 mg • Buprenorphine 6.3 mg/naloxone 1 mg
Buccal
Probuphine implant
• Buprenorphine 74.2 mg
Subdermal
Sublocade extended-release solution for injection
• Buprenorphine 100mg/0.5 mL • Buprenorphine 300 mg/1.5 mL
Subcutaneous
Subutex sublingual tablets
• Buprenorphine 2 mg • Buprenorphine 8 mg
Sublingual
Suboxone sublingual tablets
• Buprenorphine 2 mg/naloxone 0.5 mg • Buprenorphine 8 mg/naloxone 2 mg • Buprenorphine 2 mg/naloxone 0.5 mg • Buprenorphine 4 mg/naloxone 1 mg • Buprenorphine 8 mg/naloxone 2 mg • Buprenorphine 12 mg/naloxone 3 mg • Buprenorphine 0.7 mg/naloxone 0.18 mg • Buprenorphine 1.4 mg/naloxone 0.36 mg • Buprenorphine 2.9 mg/naloxone 0.71 mg • Buprenorphine 5.7 mg/naloxone 1.4 mg • Buprenorphine 8.6 mg/naloxone 2.1 mg • Buprenorphine 11.4 mg/naloxone 2.9 mg NATIONAL PAIN STRATEGY
Sublingual
Suboxone sublingual films
Sublingual, buccal
Sublingual
Zubsolv sublingual tablets
toward pain prevention. These actions are just several in a comprehensive strategy to reduce the dual crises of pain and opioid dependence. Programs to decrease inappropriate prescribing practices and opioid abuse should be balanced with quality pain management. Primary care clinicians are reluctant to prescribe opioids over concerns of dependence and opioid use disorder. Safe and effective care is a priority for all clients in preventing chronic pain. ● Understanding ways to help opioid-exposed individuals while uncovering long-term effects. ● Developing innovative treatment in all aspects of opioid addiction. ● Testing a range of non-opioid pain treatments for use in clinical practice. ● Uncovering early-stage development of non-opioid pain treatment. (NIH, 2023)
Despite the need and market opportunities for better, safer pain options, a dramatic rise in opioid use still exists and is fueled by a pain epidemic. The National Pain Strategy (2020) is a comprehensive population-level health strategy to increase recognition of pain as a significant public health problem (IPRCC, 2022). The vision is of timely access to patient care with access to effective approaches for pain self-management. Chronic pain would be recognized as a complex disease process and a threat to public health and productivity (IPRCC, 2022). Evidence-based treatment provided by primary care clinicians moves National Institutes of Health Heal Initiative ® The Helping to End Addiction Long-term® (HEAL) initiative is an effort to stem the national opioid public health crisis (NIH, 2023). NIH is a research program that optimizes the delivery of services for individuals with opioid use disorders, mental health disorders, and suicide risk (NIH, 2023). Long- term solutions for the evolving opioid crisis include: ● Partnering with communities to evaluate implementation strategies. ● Intervening in communities to prevent opioid use for at-risk individuals.
SUBSTANCE USE AND DRUG DIVERSION
drugs, and international smuggling (CSTE, 2019). Diversion can occur at any point— from the manufacturer’s distribution to the wholesalers to pharmacies and, in turn, to the patient. However, some drugs are more targeted than others: (1) anti-anxiety medications and sedatives, including benzodiazepines; (2) prescription pain medications, including opioids; (3) stimulants, including those used to treat attention deficit disorder and narcolepsy; (4) sleep aids; and (5) anesthetics, such as propofol. Healthcare providers can divert medications through false documentation, scavenging wasted medications, and theft by tampering (CSTE, 2019). Behavioral changes include subtle changes
Drug misuse typically refers to prescription drugs and is defined as using them for a purpose other than for which they were prescribed. Examples include taking higher doses than prescribed, taking longer than prescribed, using drugs for purposes other than prescribed, using drugs in conjunction with other medications that affect CNS or alcohol, and skipping doses or hoarding drugs. Drug diversion is defined as “any criminal act or deviation that removes a prescription drug from its intended path from the manufacturer to the patient,” including everything from outright theft of the drug to doctor shopping, prescription forging, manufacture or sales of counterfeit
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