Answer Addiction

Tag: opioid treatment medication

  • Deregulating Buprenorphine Could Save Thousands Of Lives, Physicians Say

    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

  • Are Rehab Centers Equipped With Meds To Treat Opioid Use Disorder?

    Are Rehab Centers Equipped With Meds To Treat Opioid Use Disorder?

    In spite of the availability of opioid addiction medications, many treatment centers have continued to rely only on abstinence programs and talk therapy. 

    A study published in the January issue of Health Affairs found that only 36% of addiction treatment centers in the U.S. carry any of the medications approved for the treatment of opioid addiction. Not only that, but only 6% carry all three: buprenorphine, naltrexone, and methadone.

    As the opioid crisis has exploded in the U.S. and abroad, cities are scrambling to combat spiking overdose deaths and the massive costs associated with the epidemic. In addition to law enforcement and education campaigns, increasing funds have been allocated to the development of medication that can treat opioid addiction.

    For many years, methadone was the only option for those who needed more than abstinence, therapy, and rehabilitation programs to combat their powerful and relentless disease. Buprenorphine and naltrexone arrived on the scene in 1981 and 1984, respectively, and have shown promising results.

    In spite of the availability of these drugs for decades, many addiction treatment centers have continued to rely only on abstinence programs and talk therapy. The study, led by Johns Hopkins School of Public Health Professor Ramin Mojtabai, looked at 10,000 outpatient facilities in the U.S. via surveys collected between 2007 and 2016.

    In 2007, only 20% of the centers offered even one of the medications, so at least some progress is being made in this respect. 

    “Medication treatment (MT) is one of the few evidence-based strategies proposed to combat the current opioid epidemic,” reads the study abstract. “The findings highlight the persistent unmet need for MT nationally and the role of expansion of health insurance in the dissemination of these treatments.”

    Image Source: NIDA

    Lindsey Vuolo, associate director of health law and policy at the Center on Addiction, assured U.S. News & World Report that these medications work.

    “Overall, approximately 50 percent of patients who receive medications for opioid addiction are successfully treated, while less than 10 percent of patients are successfully treated without these medications,” she said. At the same time, only 10 to 20% of people with substance use disorders seek any treatment at all.

    Though Dr. Mojtabai feels that increased attention to the opioid crisis may continue the trend toward more treatment centers offering addiction-combating medications, Vuolo notes that most of the facilities offering these drugs are concentrated in wealthy urban and suburban areas, and is generally more pessimistic.

    “The number of people receiving treatment has not changed significantly, even in light of the unrelenting opioid epidemic,” said Vuolo. “I don’t think research will show significant changes between 2016 and 2019 on a national scale.”

    View the original article at thefix.com