ArticleHarm reduction journal2023
Examining buprenorphine diversion through a harm reduction lens: an agent-based modeling study.
Article in Harm reduction journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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The trial behind it
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Who cites it
8 citing papers in PubMed, 10 citations in OpenAlex.
- "In My Community, if You're an Addict, People Don't Just Look Down on You for the Drugs, but for Being Black, Too": Black and Latine Methadone Patients' Experiences Around Addiction, Methadone Treatment, and Intersectional Stigma.Journal of racial and ethnic health disparities · 2026Article
- Exploring the Italian Experience with Long-Acting Buprenorphine Formulations (LAIB) for the Treatment of Opioid Use Disorder: A Series of Narrative Interviews.International journal of environmental research and public health · 2026Article
- Article
- OPOSim: An Agent-Based Model for Evaluating Long-Term Effects of Opioid Policy Outcomes in North Carolina.Journal of artificial societies and social simulation : JASSS · 2026Article
- Implementation opportunities for optimizing retention on buprenorphine treatment for people with opioid use disorder in West Virginia.Drug and alcohol dependence · 2025Article
- Medicaid managed care restrictions on medications for the treatment of opioid use disorder.Health services research · 2025Article
- Synergistic Epistasis and Systems Biology Approaches to Uncover a Pharmacogenomic Map Linked to Pain, Anti-Inflammatory and Immunomodulating Agents (PAIma) in a Healthy Cohort.Cellular and molecular neurobiology · 2024Article
- Low-Threshold Buprenorphine in Non-Traditional Settings: A Scoping Review.Substance use : research and treatmentReview
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundRecent policies have lessened restrictions around prescribing buprenorphine-naloxone (buprenorphine) for the treatment of opioid use disorder (OUD). The primary concern expressed by critics of these policies is the potential for buprenorphine diversion. However, the population-level effects of increased buprenorphine diversion are unclear. If replacing the use of heroin or fentanyl, use of diverted buprenorphine could be protective.
methodsOur study aim was to estimate the impact of buprenorphine diversion on opioid overdose using an agent-based model calibrated to North Carolina. We simulated the progression of opioid misuse and opioid-related outcomes over a 5-year period. Our status quo scenario assumed that 50% of those prescribed buprenorphine diverted at least one dose per week to other individuals with OUD and 10% of individuals with OUD used diverted buprenorphine at least once per week. A controlled prescription only scenario assumed that no buprenorphine would be diverted, while an increased diversion scenario assumed that 95% of those prescribed buprenorphine diverted and 50% of individuals with OUD used diverted buprenorphine. We assumed that use of diverted buprenorphine replaced the use of other opioids for that day. Sensitivity analyses increased the risk of overdose when using diverted buprenorphine, increased the frequency of diverted buprenorphine use, and simulated use of diverted buprenorphine by opioid-naïve individuals. Scenarios were compared on opioid overdose-related outcomes over the 5-year period.
resultsOur status quo scenario predicted 10,658 (credible interval [CI]: 9699-11,679) fatal opioid overdoses. A scenario simulating controlled prescription only of buprenorphine (i.e., no diversion) resulted in 10,741 (9895-11,650) fatal opioid overdoses versus 10,301 (9439-11,244) within a scenario simulating increased diversion. Compared to the status quo, the controlled prescription only scenario resulted in a similar number of fatal overdoses, while the scenario with increased diversion of buprenorphine resulted in 357 (3.35%) fewer fatal overdoses. Even when increasing overdose risk while using diverted buprenorphine and incorporating use by opioid naïve individuals, increased diversion did not increase overdoses compared to a scenario with no buprenorphine diversion.
conclusionsA similar number of opioid overdoses occurred under modeling conditions with increased rates of buprenorphine diversion among persons with OUD, with non-statistical trends toward lower opioid overdoses. These results support existing calls for low- to no-barrier access to buprenorphine for persons with OUD.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.