Prescription opioid users, on average, use less total opioid per day, have fewer co-occurring substance use disorders, have better family and social functioning, shorter treatment histories, are less likely to administer by injection, and experience fewer legal consequences ( Moore et al., 2007 Rosenblum et al., 2007). Indeed, evidence suggests that prescription opioid users differ in important ways from those who use heroin. However, because the approval of bup-nx derived from large-scale clinical trials conducted predominantly in heroin users ( Fudala et al., 2003 Ling et al., 1998), it was unclear the degree to which its use in those dependent upon prescription opioids would yield similar outcomes. Since its approval in 2002, buprenorphine-naloxone (bup-nx) has become a mainstay of pharmacotherapy for opioid use disorders. Treatment of prescription opioid use disorders has become extremely common in 2013, 746,000 patients received treatment for prescription opioid use disorders in inpatient locations or mental health centers ( Substance Abuse and Mental Health Services Administration, 2014), and 24% of patients who were started on pharmacotherapy for opioid use disorders primarily used prescription opioids. Although they declined slightly in 2012, they increased again by 9% in 2014, comprising the majority of all opioid-related deaths ( Rudd et al., 2016). Moreover, overdose deaths from prescription opioids climbed steadily throughout the end of the last decade. On average, more than 1000 patients per day visited an emergency department because of non-medical use of prescription opioids in 2011 ( Crane, 2015). In 2014, 4.3 million Americans used prescription opioids for non-medical reasons, making prescription opioids the second most used illicit drug ( Center for Behavioral Health Statistics and Quality, 2015). Non-medical prescription opioid use has emerged as a major public health challenge over the past two decades.

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