Advances in Psychiatric Treatment (2009) 15: 354-363. doi: 10.1192/apt.bp.108.005975
© 2009 The Royal College of Psychiatrists
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Buprenorphine prescription, misuse and service provision: a global perspective

Roger Chun Man Ho, Kai Yang Chen, Birit Broekman and Anselm Mak

Roger Chun Man Ho is a psychiatric specialist registrar at the National University of Singapore. He has a special interest in psychoneuroimmunology and addiction. Kai Yang Chen is a research assistant in the Faculty of Medicine, Dentistry and Health Science at the University of Western Australia. His current research interests are substance misuse and psychological trauma. He has also gained experience working at the Sexual Assault Referral Centre in Perth, Australia. Birit Broekman is a psychiatrist in the Department of Child and Adolescent Psychiatry, Academic Medical Centre, De Bascule, University of Amsterdam, The Netherlands. Her special interests include post-traumatic stress disorder and substance misuse in adolescents. Anselm Mak is Assistant Professor of Medicine and Rheumatology at Yong Loo Lin School of Medicine, National University of Singapore. He has a special interest in immunological complications associated with substance misuse.

Correspondence: Correspondence Dr Roger Ho, Department of Psychological Medicine, Level 5, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. Email: pcmrhcm{at}nus.edu.sg

Buprenorphine, a partial µ-opioid agonist and {kappa}-opioid antagonist, is recommended as safe and effective maintenance treatment for opioid dependence. It offers the possibility of management in primary care settings. However, its prescription has led to diversion for illicit recreational use and resulted in medical complications and, rarely, fatal overdose in combination with other sedatives. The outcome of buprenorphine maintenance programmes varies from country to country and it is determined by the local therapeutic traditions, regulatory restrictions and existing service provision for opioid misusers. This article addresses the pharmacology of buprenorphine, the benefits and drawbacks of its prescription, service provision for opioid misuse around the world, policy recommendations, and prescribing training requirements.