Crushed Buprenorphine-Naloxone Tablets

Key Messages

What Is the Issue?

• Opioid agonist therapy (OAT), including methadone and buprenorphine-naloxone, is the primary approach for managing opioid use disorder (OUD) in Canada and has been shown to reduce withdrawal symptoms and opioid use. Recent Canadian clinical guidelines prioritize buprenorphine-naloxone as the first-line treatment for OUD.
• Buprenorphine-naloxone formulations, available as transmucosal tablets or films, are effective for OUD treatment. However, there is a risk of diversion of the tablet formulation; that is, it can be distributed and used by individuals other than those for whom the drugs were prescribed. Crushing buprenorphine-naloxone tablets before administration has been proposed as a potential strategy to mitigate diversion.

What Did We Do?

• We sought to identify, summarize, and critically appraise available studies, as well as review evidence-based guideline recommendations on the administration of sublingual crushed buprenorphine-naloxone tablets for the treatment of opioid dependency.
• We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2016.
• One reviewer screened articles for inclusion based on predefined criteria.

What Did We Find?

• We did not find any evidence regarding the clinical effectiveness and safety of sublingual crushed buprenorphine-naloxone tablets for treating opioid dependency.
• We did not find any evidence-based guidelines regarding sublingual crushed buprenorphine-naloxone tablets for treating opioid dependency.

What Does It Mean?

• We identified no relevant literature on whether crushing buprenorphine-naloxone tablets effectively prevents misuse and diversion in adults with opioid dependence. As a result, no conclusions could be drawn regarding its effectiveness and safety, and no recommendations could be made.
• Additional research is needed to assess the impact of crushing buprenorphine-naloxone tablets on efficacy, bioavailability, and adverse effects to determine the clinical implications of this practice.