A survey of 117 buprenorphine prescribers in Vermont found that 91 percent backed the state's decision to remove criminal penalties for possessing diverted buprenorphine, according to a new report published by the R Street Institute in May 2026. Among people who use illicit opioids or received opioid use disorder treatment, support was nearly as strong: 80 percent of 474 participants endorsed decriminalization. The report examines efforts by Vermont, Rhode Island, and several counties to decriminalize possession of buprenorphine obtained outside formal medical channels, finding broad acceptance among both patients and providers.
Between 60 and 90 percent of individuals who use diverted buprenorphine do so for therapeutic reasons, such as managing withdrawal symptoms, bridging gaps when formal treatment isn't available, or cutting back on illicit opioid use, the report finds. Roughly 30 out of every 100,000 buprenorphine prescriptions are diverted—a rate comparable to opioid painkillers and far below antibiotics, where about 5 percent of people report taking nonprescribed doses. Among patients newly enrolled in telehealth medication for opioid use disorder, 18.4 percent reported previously using diverted buprenorphine. Only 28 percent of survey participants knew Vermont had decriminalized diverted buprenorphine, despite the policy being in effect. After Chittenden County, Vermont stopped prosecuting buprenorphine possession in 2018, overdose deaths in the region dropped roughly 50 percent from their 2017 peak, while deaths climbed 20 percent in the rest of the state.
The report states that decriminalizing diverted buprenorphine "has received broad support from people who use substances as well as healthcare providers," suggesting these changes could help reduce stigma around the medication over time. Vermont became the first state to legislatively remove criminal penalties in June 2021, allowing adults 21 and older to hold up to 224 milligrams—about a two-week supply—without facing criminal charges. Rhode Island followed one month later, eliminating buprenorphine from its list of controlled substances subject to criminal penalties. Philadelphia and Washtenaw County, Michigan also stopped prosecuting simple possession cases through prosecutorial discretion. According to the authors, concerns that decriminalization would discourage people from seeking formal treatment didn't materialize: only 4 percent of providers reported prescribing to fewer patients after the policy change, and just 4 percent of individuals aware of the policy said it led them to take more diverted medication.
The report explains that most diversion stems from a treatment gap—fewer than 20 percent of individuals with opioid use disorder receive an FDA-approved medication to treat their condition. Patients face barriers including cost, stigma, geographic isolation, and pharmacy dispensing limits, even though buprenorphine is considered effective and safe. The medication reduces illicit opioid use, overdose risk, and arrest rates while improving treatment retention and long-term outcomes. Vermont's statewide decriminalization didn't reduce overdose deaths at the population level, possibly because most residents weren't aware of the policy. However, researchers found no evidence of harm. The report recommends pairing decriminalization with other measures like authorizing telehealth prescribing, expanding pharmacist scope of practice, launching low-barrier induction programs, and removing insurance preauthorization requirements to close the treatment gap and reduce stigma that makes providers reluctant to prescribe and pharmacists unwilling to stock the medication.