Authors' objectives: What is the clinical effectiveness and safety of sublingual crushed buprenorphine-naloxone tablets for treating opioid dependency? What are the evidence-based guidelines regarding the administration of sublingual crushed buprenorphine-naloxone tablets for the treatment of opioid dependency?

Authors' results and conclusions: 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.

Project Status: Completed

URL for project: https://www.cda-amc.ca/crushed-buprenorphine-naloxone-tablets

Year Published: 2025

URL for published report: https://www.cda-amc.ca/crushed-buprenorphine-naloxone-tablets

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Canada

Organisation Name: Canada’s Drug Agency (CDA-AMC)

Contact Address: 865 Carling Ave., Suite 600 Ottawa, ON Canada K1S 5S8

Contact Name: Shannon Nordstrom

Contact Email: shannon.nordstrom@cda-amc.ca

Copyright: 2025 Canadian Agency for Drugs and Technologies in Health