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Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1812
Snenghi R. 1, Montisci M. 2
1 Unità Operativa di Tossicologia forense e Antidoping, Azienda Ospedaliera Università di Padova, Padova;
2 Sede di Medicina Legale, Dipartimento di Medicina Ambientale e Sanità Pubblica, Università di Padova, Padova
In Italy, marketing has been authorized for preparations containing high-dosage buprenorphine, for sublingual application, as replacement therapy for heroin addiction. These preparations are subject to the penal and administrative measures regarding stupefying and psychoactive substances already adopted in the past for low-dosage preparations of buprenorphine used as an analgesic. The authors examine the therapeutional use of buprenorphine, providing a final assessment of pharmaco-toxicological studies, clinical and therapeutical rationale, current legislation, and forensic problems emerging from cases examined within the Judicial framework. Among the main aspects noted were: the prevalent involvement of professional doctors and general practitioners; frequent omission of objective clinical and toxicologico-analytical checks during diagnosis and monitoring phases; constant application of incorrect dosages, methods of administration and duration of therapy; multiple prescriptions (buprenorphine + buprenorphine; buprenorphine + methadone; buprenorphine + benzodiazepines; buprenorphine + phendimetrazine); and the repeated occurrence of cases of iatrogenic addiction (the so-called “replacement abuse”) associated with buprenorphine by injection. Low-dosage maintenance therapies using buprenorphine have no true therapeutic purpose, due to the very low anti-craving effect which causes the self-maintenance of primary addiction, or diversion towards other psychoactive substances, of which some (benzodiazepines) play a significant role in the occurrence of fatal overdoses. Forensic implications must not hinder the development of territorial networks of facilities, based on the multi-disciplinary competence of addiction units, and enhancement of the role of general practitioners.