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Examining buprenorphine diversion through a harm reduction lens: an agent-based modeling study.

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Increased buprenorphine diversion may reduce fatal opioid overdoses. Our study suggests that even with higher diversion rates, buprenorphine-naloxone (buprenorphine) use by individuals with opioid use disorder (OUD) did not increase overdose deaths.

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Area of Science:

  • Pharmacology and Toxicology
  • Public Health and Epidemiology
  • Health Policy and Management

Background:

  • Recent policy changes have reduced restrictions on prescribing buprenorphine-naloxone for opioid use disorder (OUD).
  • A key concern is the potential for buprenorphine diversion, but its population-level impact on overdose rates remains unclear.
  • Diverted buprenorphine, if used to replace heroin or fentanyl, might offer protective effects against overdose.

Purpose of the Study:

  • To estimate the impact of buprenorphine diversion on opioid overdose rates.
  • To simulate opioid misuse and related outcomes over five years using an agent-based model.
  • To compare overdose outcomes under different diversion scenarios: status quo, controlled prescription (no diversion), and increased diversion.

Main Methods:

  • An agent-based model was developed and calibrated to North Carolina data.
  • Simulations included scenarios with varying rates of buprenorphine diversion and use among individuals with OUD.
  • Sensitivity analyses explored increased overdose risks, higher diversion frequency, and use by opioid-naïve individuals.

Main Results:

  • The status quo scenario predicted 10,658 fatal overdoses.
  • Increased diversion resulted in 357 (3.35%) fewer fatal overdoses compared to the status quo.
  • A no-diversion scenario showed a similar number of fatal overdoses to the status quo; increased diversion did not elevate overdose deaths.

Conclusions:

  • Increased buprenorphine diversion among individuals with OUD showed trends toward lower opioid overdose deaths.
  • Modeling indicates that diversion does not necessarily increase fatal overdoses and may be protective.
  • Findings support policies advocating for low- to no-barrier access to buprenorphine for OUD treatment.