Table 9. Buprenorphine-Containing Products FDA- Approved for Opioid Use Disorder Product Name Available Strengths
Route(s) of Administration
• Buprenorphine 1 mg/naloxone 0.2 mg • Buprenorphine 2.1mg/naloxone 0.3 mg • Buprenorphine 4.2 mg/naloxone 0.7 mg • Buprenorphine 6.3 mg/naloxone 1 mg
Bunavail buccal films
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
• Buprenorphine 2 mg • Buprenorphine 8 mg
Subutex sublingual tablets
Sublingual
• 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
Suboxone sublingual tablets
Sublingual
Suboxone sublingual films
Sublingual, buccal
Zubsolv sublingual tablets
Sublingual
NATIONAL INSTITUTES OF HEALTH HEAL INITIATIVE®
● Understanding ways to help opioid-exposed individuals and communities while uncovering long-term effects. ● Developing innovative treatment in all aspects of opioid addiction. ● Testing a range of nonopioid pain treatments for use in clinical practice. ● Uncovering early-stage development of nonopioid pain treatment.
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 (NIH, 2023): ● Partnering with communities to evaluate implementation strategies. ● Intervening in communities to prevent opioid use by at-risk individuals. Despite the need and market opportunities for better, safer pain options, a dramatic rise in opioid usage still exists and is fueled by a pain epidemic. The National Pain Strategy (2020) is a comprehensive population health–level strategy to increase the recognition of pain as a significant public health problem (Interagency Pain Research Coordinating Committee [IPRCC], 2022). The vision of timely access to patient cares with access to practical approaches for pain self-management. Chronic pain is 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 PAIN STRATEGY
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 due to concerns related to dependence and opioid use disorder. However, safe and effective care is a priority for all clients who seek to address chronic pain.
SUBSTANCE USE AND DRUG DIVERSION
Drug misuse is typically related to prescription drugs and is defined as using them for a purpose other than what they were prescribed. Examples include taking higher doses than prescribed, taking drugs for longer than prescribed, using drugs for purposes other than prescribed, using drugs in conjunction with alcohol or other medications that affect the CNS, and skipping doses/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, the manufacture or sale of counterfeit drugs, and international smuggling (Council of State and Territorial Epidemiologists [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 in appearance, increasing isolation from colleagues, inappropriate verbal/emotional responses, diminished alertness, confusion, and/or memory lapses (National Council State Boards of Nursing [NCSBN], 2018). Many healthcare workers with substance use disorders are unidentified, unreported, and untreated. These individuals continue to practice, and their impairment endangers the lives of others (NCSBN, 2018).
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Book Code: AUS3024
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