From the National Pain Report:

A drug increasingly being used to treat opioid addiction may be fueling a new epidemic of diversion, overdose, addiction and death in the United States.

The drug’s name is buprenorphine, but it is more widely known by its brand name – Suboxone – which for many years was sold exclusively by Reckitt-Benckiser, a British pharmaceutical company. Since Reckitt’s patent on Suboxone expired in 2012, several other drug makers have rushed to introduce their own formulations – hoping to grab a share of the $1.5 billion market for Suboxone in the U.S.

Two generic versions of buprenorphine were introduced earlier this year. And this month a Swedish drug maker began selling a menthol flavored tablet – called Zubsolv – that is designed to mask the bitter taste of buprenorphine. Other formulations of the drug include a film strip that dissolves under the tongue and a buprenorphine skin patch. One company is even developing a buprenorphine implant to be inserted under the skin.

“This is insanity,” says Percy Menzies, a pharmacist and addiction expert. “Buprenorphine is one of the most abused pharmaceuticals in the world.”

Buprenorphine is a narcotic, a powerful and potentially addicting painkiller that was first approved as a treatment for opioid addiction in the U.S. in 2002. When combined with naloxone to make Suboxone, the two drugs can be used to help wean addicts off opioids such as heroin, Vicodin, OxyContin, and hydrocodone. Naloxone blocks opioid receptors in the brain and central nervous system.

Over three million Americans with opioid dependence have been treated with Suboxone. Although praised by addiction experts as a tool to wean addicts off opioids, some are fearful the drug is overprescribed and misused.

A report by the Substance Abuse and Mental Health Services Administration (SAMHSA) found a ten-fold increase in the number of emergency room visits involving buprenorphine. Over half of the 30,000 hospitalizations in 2010 were for non-medical use of buprenorphine.

How many died from buprenorphine overdoses is unknown, because medical examiners and coroners do not routinely test for the drug.

The problem with Suboxone, according to Menzies, is that many addicts have learned they can use the medication, not to treat their addiction, but to maintain it. Suboxone won’t get them “high” but it will help them smooth out withdrawal symptoms between highs.

Suboxone is so popular with addicts that it has turned into a street drug – to be bartered or exchanged for money, heroin or other illegal drugs. According to one estimate, about half of the buprenorphine obtained through legitimate prescriptions is either being diverted or used illicitly.

From The New York Times:

Mike Barrett, a corrections officer, ripped open an envelope in the mail room at the Maine Correctional Center here and eyed something suspicious: a Father’s Day card, sent a month early. He carefully felt the card and slit it open, looking for a substance that has made mail call here a different experience of late.

Mr. Barrett and other prison officials nationwide are searching their facilities, mail and visitors for Suboxone, a drug used as a treatment for opiate addiction that has become coveted as contraband. Innovative smugglers have turned crushed Suboxone pills into a paste and spread it under stamps or over children’s artwork, including pages from a princess coloring book found in a New Jersey jail.

The drug also comes in thin strips, which dissolve under the tongue, that smugglers have tucked behind envelope seams and stamps.

Law enforcement officials say that Suboxone, which is prescribed to treat addiction to heroin and powerful painkillers like oxycodone, has become a drug of abuse in its own right, resulting in prison smuggling efforts from New Mexico to Maine. Addicts buy it on the street when they cannot find or afford their drug of choice, to stave off the sickness that comes with withdrawal. But some people are also taking it for the high they say it provides.

The Food and Drug Administration approved Suboxone in 2002 as the first narcotic that doctors could prescribe for addiction to opiates. Seen as a more convenient alternative to methadone, which can be dispensed only at federally licensed clinics, it blocks the effects of opiates while reducing cravings and easing withdrawal symptoms.

A spokeswoman for Reckitt Benckiser, the drug’s manufacturer, said in an e-mail that the company was “aware that a certain level of Suboxone diversion and abuse exists,” and that it had taken steps to counter it.

To deter abuse, Suboxone contains naloxone, a substance that precipitates withdrawal symptoms when the drug is injected. Suboxone also has a ceiling effect, with the effect leveling off after a certain dosage.

But users can experience euphoria, especially if they do not take it regularly, and Suboxone, whose main ingredient is buprenorphine, is increasingly sold on the street in New England and other regions where it is commonly prescribed.