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CESAR FAX December 10, 2012
Vol. 21, Issue 49
A Weekly FAX from the Center for Substance Abuse Research
U n i v e r s i t y o f M a r y l a n d , C o l l e g e P a r k
Suboxone® Sales Estimated to Reach $1.4 Billion in 2012—More Than Viagra® or Adderall ®
Sales data from the first three quarters of 2012 indicate that Suboxone retail sales in the U.S. will likely reach $1.4 billion* this year—nearly a ten-fold increase over the $137.1 million in sales in 2006 (see figure below). Suboxone currently has the 28th highest retail sales of all prescription drugs1 in the U.S., up from 198th in 2006. Suboxone sales will likely continue to increase in light of new SAMHSA regulations allowing Opioid Treatment Programs (OTPs) to dispense a multiple days’ supply of take-home buprenorphine, the main ingredient in Suboxone, to eligible patients without having to adhere to previous length of time in treatment requirements.2 The steady and rapid increase in Suboxone sales suggests that the drug is being widely adopted in the treatment of opioid dependence, likely because of its effectiveness3 and because it can be prescribed in both private physicians’ offices and OTPs.
While increased availability means that more opioid
U.S. Retail Sales of Suboxone, 2006-2012*
dependent persons are being treated, it is also likely that
diversion and nonmedical use will increase. Prior issues
of the CESAR FAX
have indicated that buprenorphine
is being diverted for use by those who do not have a
prescription and that there has been an increase in the
health-related consequences of nonmedical use of
buprenorphine.3 Furthermore, a recent State of Florida
medical examiner report4 found that the number of
buprenorphine-related deaths had increased from 6 in 2009
*Sales for the 4th quarter of 2012 were estimated using the average of
the first three quarters of 2012 (Q1: $338.8; Q2: $342.8; Q3: $393.0)
to 27 in 2011 (compared to 62 heroin-related deaths in 2011). These figures likely underestimate buprenorphine-related deaths because, unlike heroin, buprenorphine is not systematically tested for by State of Florida medical examiners.
The true magnitude and scope of buprenorphine diversion, misuse, and adverse consequences is unknown
because current epidemiologic measures do not systematically monitor buprenorphine. Routine drug testing protocols
used by workplaces and the criminal justice system may not include buprenorphine. Similarly, buprenorphine-related
deaths are not accurately tracked because medical examiners and coroners do not routinely test for the drug. We believe
that in order to maximize the effectiveness and legitimacy of buprenorphine as a treatment for opioid dependence, it is
essential that adequate systems for monitoring potential diversion, misuse, and adverse consequences be put in place
throughout the country.
According to the manufacturer, Suboxone “can cause serious life-threatening respiratory
depression and death, particularly when taken by the intravenous (IV) route in combination with benzodiazepines or other
central nervous system (CNS) depressants.”5 Failure to adequately assess the potential risks of diversion and misuse could
result in serious public health consequences and more limitations on the drug’s use.
1As ranked in the 3rd quarter of 2012. To put Suboxone sales in perspective with other commonly prescribed drugs, OxyContin was ranked 13th in the 3rd quarter of 2012, Viagra 48th, and Adderall XR 81st. Methadone did not rank in the top 100 in any year examined. Figures include sales through both retail and hospital channels. 2See http://www.ofr.gov/OFRUpload/OFRData/2012-29417_PI.pdf. 3See the CESAR FAX Buprenorphine Series
(online at www.cesar.umd.edu). 4Florida Department of Law Enforcement, Medial Examiners Commission, Drugs Identified in Deceased Persons by Florida Medical Examiners: 2011 Report
, October 2012. Online at http://www.fdle.state.fl.us/Content/getdoc/fa86790e-7b50-45f3-909d-c0a4759fefa8/2011-Drug-Report_Final.aspx (accessed 12/7/12). 5Reckitt Benckiser Pharmaceuticals Inc., “Suboxone Important Safety Information,” undated. Online at www.suboxone.com/patients/safety/Default.aspx (accessed 12/10/12). SOURCE: Drugs.com, Suboxone Sales Data
, November 2012. Online at http://www.drugs.com/stats/suboxone (accessed 12/7/12).
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Cas de Monsieur E. : diabète de type 2 J’ai choisi le cas de Monsieur E. car la diététique a un rôle essentiel dans l’amélioration du diabète de type 2 en équilibrant l’alimentation et en luttant contre l’obésité. 1. Présentation du malade : Monsieur E. est âgé de 57 ans. Il pèse 90 kg à son admission et mesure 1,68m. Son IMC est de 32 kg/m². Selon la classificati