Buprenorphine (Suboxone) was developed as an alternative to methadone that would be equally effective in treating opiate addiction but less likely to be abused. But Baltimore officials say that an underground market for the drug has developed, leading to "bupe" abuse and some deaths, the Baltimore Sun reported Dec. 16.

Unlike methadone, buprenorphine can be prescribed by individual doctors or group practices, not just distributed at treatment clinics. The drug's formula is designed to minimize its abuse potential -- it contains naloxone, which makes users sick if they ingest it -- but some users are crushing the pills and snorting or injecting the drug to get high, either filtering out the naloxone or putting up with its ill effects.

Abuse and diversion of the drug remains lower than with other narcotics, but are growing problems. Some users who get take-home doses of the drug sell part of their prescription to get cash or buy drugs; in some cases, users are selling drugs paid for by the government. In Quincy, Mass., police say that the hexagonal pills are being sold on the streets as "Stop Signs" or "Subbies."

Addicts say that buprenorphine doesn't deliver the high that heroin does, and some use the drug as a bridge between heroin doses to keep cravings and withdrawal at bay, or to take a break from heroin or other opiates.

Suboxone maker Reckitt Benckiser Pharmaceuticals Inc., said that 13 deaths have been reported since 2005 in which buprenorphine was used with other drugs.

A medical advisory panel reportedly is considering asking Reckitt to reformulate Suboxone to further minimize its abuse potential, perhaps by increasing the amount of naloxone in the pills or adding an anti-opiate agent like naltrexone.

Reckitt officials said that the public has to have realistic expectations about the drug. "Anything that has opioid-like effects, which buprenorphine does, can and will be abused by those people seeking that effect," said Rolley E. Johnson, the company's vice president for scientific and regulatory affairs.

H. Westley Clark, director of the federal Center for Substance Abuse Treatment, added, "Diversion doesn't appear to be substantial at this point ... It's hard to design a system that's 100 percent foolproof."