Globally, the majority of mental health care continues to be provided in psychiatric hospitals, and human rights abuses and coercive practices remain all too common. WHO’s new “Guidance on community mental health services: promoting person-centered and rights-based approaches” further affirms that mental health care must be grounded in a human rights-based approach.
Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy (OBOT) has rapidly expanded in the United States and abroad, and, with this increase in medication availability, there have been increasing concerns about its diversion, misuse and related harms. This narrative review defines the behaviors of diversion and misuse, examines how the pharmacology of buprenorphine alone and in combination with naloxone influence its abuse liability, and describes the epidemiological data on buprenorphine diversion and intravenous misuse, risk factors for its intravenous misuse and the unintended consequences of misuse and diversion.
Buprenorphine is approved in many countries for the treatment of opioid use disorder (OUD), but problems with diversion and abuse exist. There is a need to understand how and why patients use diverted buprenorphine, and whether barriers to access contribute to illicit use.
58% reported a history of diverted buprenorphine use, with 37% never receiving a prescription. Approximately one-half (52%) reported using buprenorphine to get high or alter mood, but few (4%) indicated that it was their drug of choice.
Global consulting leader McKinsey & Company drew unwanted attention in 2020 when a bankruptcy proceeding revealed that it guided the marketing strategy for disgraced opioid seller Purdue Pharma.
Now McKinsey is under scrutiny from Congress after revelations that at least 22 employees who were consulting for Purdue and other opioid producers were also doing work for government agencies tasked with regulating opioid use.
In a July 2019 interview, two faculty of Boston University proposed that buprenorphine start being distributed without a doctor's prescription, with only a pharmacist’s approval. Easier access means that anyone currently struggling with opioid addiction could obtain this drug whenever they chose. But it also means easing restrictions on a drug that is currently abused, sold on the illicit market and addictive. It's time to look at who might profit from their recommendations.
The US FDA has not approved any medications for the treatment of methamphetamine (METH) use disorders. Currently, cognitive-behavioral and contingency-management interventions are the most effective treatments. IXT-m200, a monoclonal antibody that specifically binds METH in the blood, is being developed as a pharmacological treatment for use in conjunction with behavior therapies. Based on nonclinical studies, IXT-m200 is expected to alter METH pharmacokinetics in human subjects resulting in reduced or blocked METH subjective effects that reinforce METH use.
In 2018, McKesson committed the astronomical sum of $100 million to support a new non-profit group, the FORE Foundation. Is there any reason, really, to think twice about this collaboration between McKesson and the FORE Foundation? The answer might be "yes." This type of action was one of the tactics used by Purdue Pharma to smooth the path to increased opioid prescribing—getting a non-profit to spend your money making increased use of your products possible. In the end, even this move could be all about profits.