P11 Perceiving the diversion potential of the buprenorphine/naloxone combination in taiwan

BackgroundThe buprenorphine/naloxone combination was first introduced in Taiwan in 2005 and has since been widely used in clinical settings to treat opioid dependence. This medication can be prescribed by any physician with a valid license. The other treatment option is methadone, but its use is strictly supervised by psychiatrists only and distributed through government-certified hospitals. Considering the relatively loose architecture (a concept of sociologist Shobita Parthasarathy) of the buprenorphine/naloxone combination, diversion has become a potential public-health concern.ObjectivesThis study aims to examine the diversion potential of the buprenorphine/naloxone combination from the perspective of healthcare providers and situate this medication’s „perceived potential in an architecture of pharmaceutical governance taking form out of institutional, professional, and social conditions.MethodsData are collected by reviewing relevant archives encompassing academic journals, newspapers, official and professional documents, and statistical reports. Additionally, in-depth interviews were conducted with 20 professionals who were involved in the distribution and management of the buprenorphine/naloxone combination.ResultsThe architecture of buprenorphine/naloxone governance is best characterised as a sociomaterial assemblage taking shape in a historical process. On the social side are ingrained discrimination against people who use drugs, slow acceptance of addiction as a medical illness, exclusion of addiction from the coverage of national health insurance, competition of imported medicine and local generics, and professionalisation of addiction medicine. On the material side are the pharmacological properties of buprenorphine and naloxone, as well as the drug design that renders the combination safe and convenient. All of these factors combine to make the buprenorphine/naloxone tablet liable to diversion.ConclusionsThe notion of architecture as a sociomaterial assemblage is a useful theoretical tool to understand how a substance prevails in its societal environment and interacts with it.