Preventing Abuse and Diversion

Waivered physicians can take several measures to minimize the risk of buprenorphine abuse and diversion. Of fundamental importance is documenting all information that is relevant to the patient's treatment, including the results of a thorough physical exam, which can reveal needle wounds, a perforated septum, or other signs of past drug abuse (Katz, 2007).

In addition to screening for patients who pose an abuse or diversion risk, try these preventative measures:

  • Perform random callbacks, pill counts, and observed dosing: If you suspect patients are diverting buprenorphine, you may want to perform a callback where they have to bring their remaining supply of medication in for you to inspect. This policy should be outlined in the patient contract and should state how much notice the patient will be given beforehand.
  • Conduct periodic but random urine toxicology screen for buprenorphine.
  • Limit the prescription quantity and number of refills that you provide.
  • Write prescriptions in pen.
  • Do not pre-print your DEA registration number on prescriptions.
  • Consider using prescription forms which have preprinted numbers on them for the quantity of refills. You can circle the prescribed number, and strike through the other numbers to make it very clear to the pharmacists which quantity the patient should get (Gibbs and Haddox, 2008).
  • Utilize state prescription monitoring programs: These programs provide databases of prescriptions of certain classes of drugs (schedule II-IV, varies depending on the state) issued and can help to identify forgery, improper prescribing, and drug-seeking, or doctor-shopping patients.
  • In 2005, NASPER – The National All Schedules Prescription Electronic Reporting Act was passed and provides $60 million to create a federal grant program to help states help start or improve state-run prescription monitoring programs. As of September 2009, 33 states have implemented prescription monitoring programs.
  • A current list of states with prescription monitoring programs can be viewed here.
View ReferencesHide References
Gibbs LS, Haddox JD. Lawful prescribing and the prevention of diversion. J Pain Palliat Care Pharmacother. 2003; 17(1): 5-14 .
Katz NP, Adamds EH, Beenyan JC, Birnbaum HG, Budman SH, Buzzeo RW, Carr DB, Cicero TJ, Gourlay D, Inciardi JA, Joranson DE, Kesslick J, Lande SD . Foundations of Opioid Risk Management . Clinical Journal of Pain. 2007 ; 23(2): 103-118 .
Related Resources: 
Description: 
This is the NASPER website which includes various information on the $60 million dollar 2005 grant to help states start or improve state-run prescription monitoring programs (PMPs).
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American Society of Interventional Pain Physicians
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Physician stage in practice: 
Description: 
These FAQs address common questions regarding prescription drug monitoring programs.
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Drug Enforcement Agency (DEA)
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Description: 
This is a list of each state's prescription monitoring program contact information.
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National Association of State Controlled Substances Authorities (NASCSA)
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