Tag: medication-assisted treatment

New Bill Aims To Deregulate Buprenorphine & Other Addiction Treatment Meds

The proposed bill would remove the extra barrier that prevents all doctors from being able to prescribe opioid treatment meds.

The movement to deregulate drugs that treat opioid addiction is gaining steam in New York with the support of 18 state public health directors and U.S. Rep. Paul Tonko, who will soon introduce federal legislation to make it easier for doctors to prescribe medications like buprenorphine.

Currently, prescribers need special training and permission to give out addiction treatment drugs which they don’t need to prescribe opioid pain medications like oxycodone. The proposed bill would remove that extra barrier.

“These professionals can use their training and skill and ability to provide medication for treatment of pain,” said Tonko to STAT News. “But when it comes to addressing the illness of addiction, they have to jump through additional hoops.”

Buprenorphine, a major ingredient in medications like Suboxone, is an opioid initially designed to relieve pain without producing as many side effects as morphine. Though it is possible to abuse and become addicted to buprenorphine, opioid-tolerant individuals are generally unable to get high on controlled doses. It can therefore be used to treat cravings and withdrawal symptoms without getting patients high.

Opponents have expressed concern that deregulation could result in an increase in diversion and misuse of these drugs. However, addiction experts say that most illegal use of buprenorphine and similar drugs is used to treat addiction rather than for recreation. If access to addiction-treating drugs is expanded, they argue, non-prescription use should decrease.

“We want people to be getting medication from health care providers,” says addiction medicine specialist Dr. Sarah Wakeman. “The question with buprenorphine diversion is how you best reduce its non-prescribed use—and the answer is probably expanding access to treatment.”

Less than 7% of health professionals hold the DEA waivers necessary to prescribe addiction treatment medications. Currently, physicians need to go through an extra eight hours of training in order to obtain these waivers, and nurses and physician assistants have to complete 24 hours of training.

The lack of available prescribers means that even those who seek out addiction treatment may have to see a different health professional just to obtain a prescription for buprenorphine.

In March 2019, two physicians published a call for the deregulation of buprenorphine, saying that it could save thousands of lives. They cited the example of France, which removed additional restrictions on prescribing opioid addiction treatment drugs in 1995 and saw an 80% decrease in opioid overdose cases in the following years.

With opioid overdose deaths in the U.S. drawing close to 50,000 each year, even “just” a 50% decrease could save tens of thousands of lives.

View the original article at thefix.com

4 May 2019
Programs Aim to Bridge Addiction Treatment Gap After Jail

Treatment programs both public and private are working to keep newly-released inmates on the right track.

Programs are popping up around the country aiming to help people with substance use disorder stay sober after they are released from jail—a time that can be especially dangerous for those who have been in forced sobriety while behind bars but were not given the necessary treatment to stay sober on the outside.

“A lot of people come out of prison, and they don’t have anything, and it’s really hard to be successful,” Judge Linda Bell, who presides over an opioid court in Las Vegas, Nevada, told News3 Las Vegas.

The program that Bell oversees helps people released on parole stay sober by connecting them with medication-assisted treatment, housing, counseling and other supports.

“If it’s still available, I’d like to stay an extra month and continue to stay in sober living,” parolee Clayton Dempster told Bell during a recent court hearing.

Bell does her best to help people like Dempster stay sober, but also imposes consequences if they’re not adhering to the terms of their release by staying in recovery.

“I have frequent status checks to make sure all of that is going well. If it’s not, I might impose community service or even a short jail sanction,” she said.

While programs like the one Bell runs, which is grant funded, are part of the criminal justice system, other programs outside the system are also trying to help newly-released inmates stay sober.

In Baltimore, a privately-funded van parked outside the city jail helps people connect with many of the same services provided in Bell’s courtroom, like medication-assisted treatment—bridging the gap that opens when people are released from jail but not put in touch with ongoing services.

“This program works,” Michael Rice, a client of the van, told Vox.

Without a functioning government system to help people, especially in cities like Baltimore, private organizations and foundations are left providing lifesaving treatment to people at risk.

“There are plenty of high-threshold options, but not enough low-threshold options,” said Natanya Robinowitz, executive director of Charm City Care Connection, which provides treatment services in Baltimore. “If you had a functioning system, it would be very low-threshold.”

Because access to treatment can be prohibitively expensive, especially for people who don’t have insurance, jails have become the default detox and treatment facilities for people with substance use disorder.

Because of that, there has been more recent support for evidence-driven treatment options like medication-assisted treatment, but still only about 12 percent of jails provide it. Fewer still provide services after a client leaves. However, even in the law enforcement community people are beginning to realize that treatment provided in jails and after release can be lifesaving.

“We know if you are an opiate user you come in here, you detox, and you go out—it’s a 40% chance of OD-ing,” said Carlos Morales, the director of correctional health services for California’s San Mateo County. “And we have the potential to do something about it.”

View the original article at thefix.com

1 May 2019
Feds Undertake Four-State Study to Address Opioid Crisis

The $350 million research project aims to find a way to reduce opioid deaths by 40% within 3 years.

The National Institutes of Health (NIH) is gearing up to dole out $350 million to Kentucky, Massachusetts, New York and Ohio to figure out how to stop opioid deaths by 40% in those states over the next three years.

By disbursing the money to the University of Kentucky, Boston Medical Center, Columbia University and Ohio State University, the NIH hopes to curb fatalities from drugs like fentanyl and heroin, which took the lives of about 47,600 people in the U.S. in 2017.

Researchers will get deeply involved with 15 communities that have been hit hard by the opioid crisis to figure out how best to effectively prevent and treat addiction there. They’ll also take a hard look at how factors like unemployment and the justice system contribute to the continued crisis, and experiment with distributing anti-overdose medications to first responders, police, and even schools.

“The most important work to combat our country’s opioid crisis is happening in local communities,” said Alex Azar, U.S. Health and Human Services Secretary. “We believe this effort will show that truly dramatic and material reductions in overdose deaths are possible, and provide lessons and models for other communities to adopt and emulate.”

The program will proceed no matter what kind of budget cuts the NIH faces, according to Azar. This is welcome news as some experts believe there is no time to waste.

“We are in such a period of crisis that we need to know in real time what is working and what is not working,” said Dr. Alysse Wurcel of the Tufts Medical Center in Boston.

The opioid crisis is a major issue that requires a multi-faceted approach to solve. On his show, Last Week Tonight, John Oliver called for holding members of the Sackler family, the minds behind OxyContin, accountable for their alleged aggressive and irresponsible marketing of their powerful opioid painkiller. Oliver had several celebrities dramatize testimony given by Richard Sackler.

“The launch of OxyContin tablets will be followed by a blizzard of prescriptions that will bury the competition,” performed Michael K. Williams, repeating Sackler’s infamous proclamation. “The prescription blizzard will be so deep, dense and white.”

Some solutions to the opioid crisis may seem unorthodox and unintuitive, such as a Canadian public health expert’s suggestion to install opioid vending machines in Vancouver, home to “one of North America’s densest populations of injection drug users.” Only proven chronic drug users could scan themselves to get clean drugs for safer consumption.

“We’re acknowledging people will go to any extreme to use this drug. To tell them not to use because it’s unsafe is ridiculous,” said program mastermind Dr. Mark Tyndall.

View the original article at thefix.com

22 April 2019
DOJ Accuses Indivior Of Illegally Marketing Suboxone Film

The drug company is accused of promoting its sublingual film strips as safer and less abusable than other opioid treatment drugs.

A British pharmaceutical company was indicted by the U.S. Department of Justice (DOJ) on charges of fraud involving its Suboxone film medication, which is used to treat opioid dependency.

The DOJ alleged that Indivior reaped “billions of dollars in revenue” by engaging in an “illicit nationwide scheme” to promote its sublingual film strips as safer and less abusable than other opioid treatment drugs, and further sought to boost profits with a helpline for prospective patients that allegedly diverted them to physicians that prescribed Suboxone.

Indivior refuted the charges in an eight-page rebuttal, but were unable to stop their stock from dropping by 71% after the DOJ issued its indictment on April 9.

Indivior developed its Suboxone film strips in 2007 as an alternative to the tablet form of the drug, which was facing competition from generic products. Both the tablet and the film strips contain buprenorphine, an opioid used in medication-assisted treatment (MAT) for opioid dependency, and itself a highly addictive drug.

The DOJ alleged that Indivior marketed its Suboxone film as safer and less-divertable than the tablet modality, and “aggressively marketed” the film as having a “lower risk of child exposure,” despite lacking any scientific evidence to support those claims.

Prosecutors found that the film strips could actually be more hazardous to children, due to their fast dissolution when placed under the tongue and formulation that made them “taste better.” The DOJ also claimed that Indivior lied when it announced the end of production for Suboxone tablets in 2012 due to “concerns regarding pediatric exposure,” when, as the indictment noted, the real reason was to delay the Food and Drug Administration’s approval of generic forms of Suboxone.

Additionally, the indictment alleged that Indivior diverted more patients to its film strips through an internet and telephone resource program. The “Here to Help” line connected opioid-dependent patients to doctors that it knew were prescribing Suboxone and other opioids at an amount and dosage greater than allowed by federal law, and in some cases, under suspect circumstances.

The alleged scheme proved successful for Indivior, which saw sales of Suboxone Film strips jump from $83 million in 2010 to $843 million in 2014, according to the DOJ indictment.

Thousands of patients reportedly switched prescriptions to Suboxone film as a result of the company’s allegedly fraudulent promotion, and state Medicaid programs expanded and maintained coverage of Suboxone film at a “substantial” cost to the U.S. government.

The DOJ indictment charged Indivior with one count of health care fraud, four counts of mail fraud and 22 counts of wire fraud, as well as conspiracy to commit all three aforementioned charges. The indictment is only an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt.

In a statement, Indivior chairman wrote that his company “conducts more research into opioid addiction than any other company, and the products it has brought to market have helped millions of people struggling with opioid addiction.” He added that he was surprised that the DOJ would indict a company for claims that “the government’s own researchers believe are true.”

The news of the indictment sent Indivior’s stock price sliding from $100 a share to approximately $30 a share on April 10.

View the original article at thefix.com

15 April 2019
Why Aren't More Doctors Embracing Medication-Assisted Treatment?

A new op-ed suggests that concerns about “branding” may deter many doctors from offering medication-assisted treatment (MAT) for opioid use disorder.

A new op-ed on STAT News highlights a troubling concern in regard to medication-assisted treatment (MAT).

Author David A. Patterson Silver Wolf, PhD, opined that the reason why methadone, buprenorphine and naltrexone aren’t more widely used to treat opioid use disorders (OUDs) may be due to “branding”—specifically, concern on the part of primary care physicians about the stigma associated with OUDs and its effect on their practice.

But as Silver Wolf noted, the toll taken by the opioid epidemic on individuals and families all but required physicians to undertake the necessary steps to prescribe MAT, despite any qualms they may have.

In the article, Silver Wolf, an associate professor at Washington University in St. Louis, Missouri and faculty member for training programs funded by the National Institute on Drug Abuse (NIDA), wrote that he came to his opinion after participating in a national panel of addiction experts that produced “Medications for Opioid Use Disorder Save Lives,” a report from the National Academies of Sciences, Engineering and Medicine.

In the report, he and his fellow experts noted that while the need for medication-assisted treatment is sizable, and drugs like methadone and Suboxone have been approved as safe and effective treatments for OUD by the Food and Drug Administration (FDA), only a small number of physicians have signed up for the necessary training by the Drug Enforcement Administration (DEA) to be able to prescribe it.

Silver Wolf also cited another STAT opinion piece, which speculated on some of the reasons why more physicians haven’t been lining up to prescribe MAT. One deterrent may be the process for receiving a federal waiver and the specialized training required to administer this treatment.

But he also suggested that concern over the perception of those with substance use disorders by other patients may also color certain medical professionals’ opinions, who fear that the inclusion of such individuals to a patient base may negatively impact business.

“Physicians whose practices focus on patients with opioid use disorder don’t have to worry about their ‘brand’ being harmed because it is tied to this treatment and this patient population,” Silver Wolf wrote. “But a typical primary care physician in Manhattan or suburban Atlanta or rural Nevada might worry about the potential trouble that patients with addictions might cause in their waiting rooms.”

The answer, according to Silver Wolf, is for more physicians to look past financial concerns and stigma, and take the steps to make medication-assisted treatment a part of their practice—even though, he adds, that many will not.

But if individuals and families impacted by the addiction crisis—what the National Academies committee has come to view as an “all-hands-on-deck” situation—then Silver Wolf believes that physicians need to do the same.

View the original article at thefix.com

3 April 2019
How Suboxone Helped Me Until I Could Help Myself

I felt confident that I had no desire to use opioids again, not because the Suboxone had eliminated my cravings, but because I had changed my life. The pain I worked so hard to anesthetize with heroin had been addressed.

Suboxone, while often controversial among addiction treatment professionals and people in recovery, has moved to the forefront in discussions about opioid treatment. The recovery community has no shortage of naysayers insisting that medication-assisted treatment (with drugs such as Suboxone, buprenorphine, and methadone) is simply trading one addiction for another, characterizing it as heroin in legal form and just another way for the big pharma companies – who are already blamed for the initiation of the opioid epidemic – to pull in profits. But Suboxone is not an illicit street narcotic with fatal overdose rates surpassing even automobile accidents, it’s a life-saving tool that many experts insist is our best hope for the current public health emergency.

Medication-Assisted Treatment Is Effective, But Stigmatized

According to Dr. Gavin Bart, Director of the Division of Addiction Medicine at Hennepin County Medical Center and Associate Professor of Medicine at the University of Minnesota, opioid addiction requires long-term management; behavioral interventions alone have extremely poor outcomes with more than 80% of patients returning to drug use.

“Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function,” Bart writes. “Extensive research shows that each of the three available medications used to treat opiate addiction have superior treatment outcomes to non medication based therapies. Increased retention reduces mortality, improves social function, and is associated with decreased drug use and improved quality of life.”

Abstinence proponents may be skeptical about Bart’s research, but for me, it rings true. Reduction in illicit opiate use? Check. Decreased craving? Check. Improved social function and improved quality of life? Check, check. Abstinence-based treatment did not save my life. Medication-assisted treatment paired with specialized addiction therapy helped me save my own life.

As an active member of the recovery community, I am mostly outspoken and typically very candid, even when it comes to mortifying revelations. And even for me, Suboxone is a touchy subject. I am more comfortable discussing random substances I’ve injected than I am discussing how Suboxone was a key player in my opioid addiction treatment. I think my discomfort is a result of the negative rhetoric that surrounds the medication, and ironically enough its harshest critics are often other people in recovery. The prejudice against medication-assisted treatment is harmful, and even deadly when the negative discussion derails someone from seeking the help that, according to the evidence base, may give them the best chance of staying alive.

Is medication-based treatment the perfect fix to a horrific and increasingly deadly addiction? No. Suboxone has its burdens. I grappled with those too. When I first started taking Suboxone, I’d take it for a week and then relapse on heroin. I did that a handful of times before I was finally serious about getting clean.

My Suboxone Journey: From Relief to Frustration

My initial Suboxone dose was 8 mg buprenorphine with 2 mg naloxone. It was an orange strip with a tangy taste that I’d place under my tongue and wait while it dissolved into my bloodstream. Because I essentially switched directly from heroin to Suboxone (taking the first dose when I began experiencing opioid withdrawal symptoms), I didn’t have to suffer the weeks-long detox that frequently triggered my repeated relapses.

Taking my daily dose of Suboxone was like a sigh of relief at the beginning: one more day that I didn’t have to suffer through withdrawal. But after a few years, the sighs of relief eventually turned into sighs of disdain. My once-considered reprieve from the consequences of my addiction was starting to feel like a rusty pair of shackles. I was sick of going to the doctor and refilling my prescription, I was sick of keeping this secret from everyone in my life, I was sick of being terrified to travel. This thing that had once made me feel normal now had me feeling like I was still, after so much time, tied to my painful past of addiction.

Nothing else in my life reminded me of my past. There were no remnants of my previous addict self. I didn’t associate with any of my old using friends, I hadn’t seen or spoken with any dealers in ages, I never even got pulled over for traffic stops. I didn’t look like a junkie anymore and I didn’t act like one either. I had nurtured and repaired the ties with my family, I had a loving, healthy relationship, and I was well on my way to getting a college degree. I had successfully restored myself to sanity, as good ol’ Bill would say.

Fear kept me stagnant, which didn’t feel fair. I had come so far and was nothing like the junkie I once was, but I still had this inevitable withdrawal from Suboxone hanging over my head. My one final detox. The big whopper. How would I go through with it? I was in school so I couldn’t miss two to four weeks of classes, and anytime a summer or winter break neared, I’d chicken out, despite telling myself it was time and trying to prepare for it. In the meantime, I’d slowly been cutting down. I went from the initial dose of 8 mg buprenorphine/2 mg naloxone strips to 4 mg/1 mg, and then even further to 2 mg/.5 mg.

Suboxone Withdrawal

I had no idea what to expect. Like many of us, I have some form of post-traumatic stress disorder from my time in active addiction, and a major part of that was the horrendous withdrawals. I was completely fixated on these impending withdrawal symptoms, and there was nothing I could do — I had to pay the debt.

I finally made the decision to go through with it. I made the appropriate arrangements and was prepared to suffer for a couple weeks minimum, several weeks or maybe even months maximum. I watched YouTube to try to ease my frazzled nerves, but the videos pacified my anxiety like a game of Russian Roulette. Do not watch YouTube. Some videos had people detoxing, drenched in sweat and sobbing into the camera and others had people after just a week saying, “Not so bad guys!”

The night before I took my final dose, which was a teeny tiny square cut from a buprenorphine 2 mg/naloxone .5 mg strip, I curled up into the fetal position, buried myself under my duvet and cried myself to sleep. I couldn’t believe I was about to enter junkie limbo after living as a functioning member of society for so long.

The first few days weren’t pleasant, but it was nothing like I’d experienced in the past. I couldn’t sleep, I tossed and turned, I had tingling chills and clammy sweats, general anxiety and a sense of unease. I once detoxed from a $100 a day heroin habit and it was like I was the star of an exorcism horror film; compared to withdrawals like that, this one wasn’t nearly as bad as I’d anticipated. I think spending so much time tapering down to as small a dose of suboxone as I could handle really paid off when it came time to detox.

Another big fear I had, mostly thanks to Google and YouTube, was post-acute withdrawal syndrome (PAWS). After the initial detox, the last time I felt any symptoms I knew were directly related to my withdrawal was about a month and a half after day one. I had a mini-panic attack when Target was too crowded. I started pouring sweat, rushed to my car, and burst into tears. And after that, I’ve simply felt normal. That thing we all desperately want to feel: “normal.”

What If?

The detox was tough, it was emotionally taxing and physically draining. But I realized that it was the fear of the withdrawal that had me suffering the way I was. It was a fear of the symptoms and a fear of the unknown. I felt confident that I had no desire to use opioids again, not because the Suboxone had eliminated my cravings, but because I had changed my life. The pain I worked so hard to anesthetize with heroin had been addressed. I did deeply introspective work in therapy and I changed my social environment, all while using Suboxone. I built up my self-worth by investing in myself and investing in healthier relationships, things I never could have done while still using heroin. I fixed my broken coping mechanism, I knew how to handle stress and sadness. Yet, there was still this tiny sliver of me that wondered, “what if?”

What if it was all some magical mask that Suboxone created and none of this was reality and as soon as I stopped taking it I would revert to my old tormented life?

That is what prompted me to finally write this piece — realizing that regardless of the discomfort I feel discussing Suboxone, there are other people in recovery using medication-assisted treatment right now, scared to talk about it and scared to get off, experiencing the exact same fears that plagued me. Once I made the leap and decided to go ahead with my final detox, and then when it was complete, I felt free. Finally free. Not because Suboxone had me stuck, but because Suboxone helped me move past the hardest time of my life. This withdrawal was the final chapter to that saga and it was finally over — and I survived.

I closed the book, I’d won the war.

View the original article at thefix.com

25 March 2019
Virginia Eases Suboxone-Prescribing Restrictions

The policy change will increase access to the medication and reduce delays in treatment.

Prior authorization will no longer be required for Virginia physicians to prescribe a form of the opioid addiction medication, Suboxone, to patients.

The state’s Department of Medical Assistance Services (DMAS), which oversees the Virginia Medicaid program, has removed the authorization requirement for Suboxone film (a film applied to the tongue). Suboxone is a brand of buprenorphine that assists individuals in reducing or quitting their dependencies on heroin or prescription opioids.

Acting chief medical officer of the DMAS, Dr. Chethan Bachireddy, said in a press release that his agency has “a responsibility to understand and to meet the needs of our members and the providers who treat them.”

Before the policy change, Virginia physicians were required to obtain prior authorization from DMAS or one of its contracted health plans to prescribe Suboxone film.

According to the Virginia Mercury, the change will increase access to the medication and reduce delays in treatment.

The Virginia Mercury also cited a recent study by Virginia Commonwealth University that found that the expansion of Medicaid—approved by voters in 2018—will provide as many as 60,000 uninsured Virginians with access to treatment services for dependency issues, including 18,000 with opioid dependency.

In all, 400,000 Virginia residents are expected to gain access to coverage in 2019.

Data culled from the office of the state’s chief medical examiner in January 2019 found that 1,229 Old Dominion residents died as a result of opioid-related overdose in 2018—the same number of fatalities that occurred in 2017. However, the total number of 2018 fatalities will not be available until this spring.

The revision of the authorization requirement applies only to Suboxone film, but not to other forms of buprenorphine that are not on the Medicaid preferred drugs list.

But buprenorphine, often in conjunction with counseling, has proven to be effective in lowering death rates among those who have suffered a previous overdose. The DMAS press release cited a study that suggested that among overdose survivors, there was a 40% decrease in the death rate of those who used Suboxone, compared to those who did not.

Bachireddy described the revision as one of several “effective, proactive strategies that are putting Virginia at the forefront in the fight against the opioid crisis.”

View the original article at thefix.com

22 March 2019
Woman Sues To Continue Methadone Treatment In Prison

“I am afraid for my life and my safety if the Bureau of Prisons withholds medicine that I know I need,” the woman said in court filings.

For Stephanie DiPierro, methadone has been a lifesaving treatment. It helped her get sober from an opioid addiction in 2005, and since then has helped her stay away from illegal opioids.

Now, DiPierro is suing the federal prison system for her right to use methadone while she serves her sentence.

“Methadone gave me my life back,” DiPierro wrote in court filings, according to The New York Times. She said that without methadone, her life is at risk. “I will lose control of my addiction and I will relapse, overdose and die.”

Next month, DiPierro, who has bipolar disorder and anxiety, is set to start serving a year-long prison sentence. However, she argues that the Federal Bureau of Prisons’ ban on inmates (other than pregnant women) using methadone amounts to cruel and unusual punishment.

In court filings she wrote, “I am afraid of what it will mean to lose my methadone treatment at the exact moment when I am put in the most anxiety-producing situation of my life. I am afraid for my life and my safety if the Bureau of Prisons withholds medicine that I know I need.”

DiPierro is being represented by the American Civil Liberties Union of Massachusetts. ACLU staff lawyer Jessie Rossman says that in addition to being cruel and unusual punishment, denying DiPierro methadone treatment is discrimination.

“The Bureau of Prisons is denying her a reasonable accommodation for her disability, and also discriminating between different disabilities. Inmates with chronic conditions like diabetes are allowed to continue to take their medically necessary treatment,” Rossman said. “What’s now coming across loud and clear is that the standard of care to treat opioid use disorder is medication-assisted treatment, and it’s ineffective and unlawful to prevent individuals from accessing their treatment and medication for that disease.”

Jails and prisons generally do not allow methadone. Some argue that this is because methadone is an opioid that can be diverted and abused, while others argue that it’s an arbitrary rule based on discrimination against people with substance use disorder.

Last year, Rossman represented a Massachusetts inmate who was looking to continue methadone treatment in county jail. A district court judge in Massachusetts issued a ruling that denying inmates methadone treatment is in violation of the Americans With Disabilities Act and the constitutional ban on cruel and unusual punishment.

Former head of the Office of National Drug Control Policy (ONDCP) Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center, told The New York Times that the ruling would likely set the stage for far-reaching change.

“One thing this ruling says is that, one way or another, either by legislation or by legal mandate, jails and prisons are going to have to do this,” he said.

View the original article at thefix.com

19 March 2019
Deregulating Buprenorphine Could Save Thousands Of Lives, Physicians Say

Fewer than 7% of US physicians currently have the DEA waivers necessary to prescribe buprenorphine.

An opinion piece by two physicians published in STAT Tuesday argues that deregulation of the opioid addiction treatment drug, buprenorphine, could save tens of thousands of lives every year.

The authors, University of Rochester Professor Kevin Fiscella and Sarah E. Wakeman, director of the Massachusetts General Hospital Substance Use Disorders Initiative, strongly believe that making it as easy to prescribe buprenorphine as OxyContin or fentanyl is essential to the fight to end the opioid epidemic in the U.S.

According to Fiscella and Wakeman, less than 7% of physicians in the country currently have the DEA waivers necessary to prescribe buprenorphine.

Buprenorphine and methadone are currently the only approved drug therapies for opioid addiction disorders and is considered much safer than prescription opioids used to treat pain.

However, doctors and nurse practitioners must jump through extra hoops in order to obtain permission to prescribe buprenorphine, while all DEA-licensed physicians are allowed to prescribe OxyContin and fentanyl.

According to the Florida Academy of Physician Assistants (FAPA), all physician assistants need only to take a three-hour course in order to obtain a DEA license allowing them to prescribe controlled substances, including opioids. In contrast, physician assistants must go through 24 hours of training in order to prescribe buprenorphine on top of the training for the standard DEA license.

An increasing number of studies have found that the over-prescription of OxyContin and, more recently, the misuse of the incredibly potent opioid fentanyl together have fueled an epidemic that killed close to 50,000 people in 2017 and likely more in 2018. So why, Fiscella and Wakeman ask, is a safer opioid that is approved to treat opioid addiction more difficult to prescribe?

In order to prescribe buprenorphine, medical professionals must complete extra training, apply for a specially marked license, and agree to allow the DEA to inspect their patient records. All of these extra steps both increase stigma against addiction disorders and place unnecessary barriers in front of what is widely considered to be effective treatment for this massive problem.

“Patients often experience barriers trying to fill prescriptions for buprenorphine—told they cannot fill it if the “X” is missing from the prescriber’s license number—or feel shamed when filling buprenorphine prescriptions,” the authors wrote. “Some feel embarrassed telling other doctors they are taking buprenorphine.”

Fiscella and Wakeman conclude that deregulating buprenorphine—essentially making it as easy to prescribe as OxyContin and fentanyl—would increase treatment rates for opioid addiction and cause deaths from overdose to plummet. They cite policy in France which implemented this kind of deregulation in 1995 and resulted in a whopping 80% decrease in opioid overdoses.

“[E]ven if deregulation of buprenorphine prescribing led to ‘just’ a 50% decrease, that would mean 20,000 fewer deaths.”

View the original article at thefix.com

14 March 2019
Opioid Treatment Specialists Struggle To Address Sexual Dysfunction In Patients

Addiction experts worry that people with opioid use disorder may stop medication-assisted treatment due to the side effect of sexual dysfunction.

People treating their opioid addiction with drugs like methadone and buprenorphine often struggle with sexual dysfunction, according to a report in Filter.

All opioids lower the amount of free and available testosterone in the human body, and lower testosterone levels are directly associated with a lower sex drive and more difficulty achieving orgasm regardless of gender. However, the actual source of sexual dysfunction can be difficult to determine, and obtaining treatment can be even more challenging.

According to Dr. Alan Wartenberg, former president of the Massachusetts chapter of the American Society of Addiction Medicine, 30 to 40% of individuals taking methadone and 20% of those taking buprenorphine experience sexual dysfunction.

The chances of experiencing this problem increase, the higher the dose of the medication, but some patients may have a low sex drive and related issues due to other aspects of recovery such as stress, co-occurring mental illness, and other medications taken in addition to the methadone or buprenorphine.

Regardless of the source of the problem, medical professionals involved in addiction treatment stress that sexual dysfunction in recovering individuals needs to be addressed. Some patients may leave treatment if the issue becomes intolerable.

Sexual functioning is considered a key aspect of one’s quality of life. Getting better might not seem worthwhile if a decent sex life is not in one’s future. Sexual dysfunction can also make it more difficult to get pregnant.

“I remember as an administrator at the clinic, there were some patients that decided to end their treatment for a number of reasons, including the issue of having a lowered sex drive,” said President Mark Parrino of the American Association for the Treatment of Opioid Dependence.

In order to effectively address this problem, experts believe that people in addiction recovery need a comprehensive evaluation in order to discover the true cause of sexual dysfunction and determine the best treatment approach.

In anyone else with issues relating to sex, a specialist would be seen and tests would be done to measure hormone levels and screen for depression and performance anxiety. Unfortunately, the social stigma surrounding addiction creates a barrier for those in recovery.

“[T]he American attitude about addicts is that addicts are sick, they need help, but they’re also sinners so we shouldn’t help them too much,” said founding director of the Integrated Substance Abuse Programs at UCLA, Dr. Walter Ling.

At the same time, it’s difficult to find doctors who have a good understanding of both addiction and sexual dysfunction. There is also a general stigma around the issue of sexual dysfunction, and the problem is not well understood in women. This lack of understanding has resulted in a lack of effective treatments for female sexual dysfunction (FSD).

Dr. Karen Boyle, a urologist at the Johns Hopkins Hospital, believes that the lack of treatment options makes it difficult for people to take FSD seriously.

“The gender bias still exists,” she said in an interview with ABC News. “We have so many really good medical treatments for men. When the FDA approves a drug for the treatment of FSD it will give real credibility to the biological basis of this type of disease.”

All of these issue combined makes it very difficult for women in recovery from opioid addiction to address sexual dysfunction.

View the original article at thefix.com

9 March 2019