There’s No Medical Justification to Limit Access to Life-Saving Opioid Treatment Buprenorphine
There is a long standing federal policy in the U.S. limiting access to life-saving treatments for people addicted to opioids. One of the most effective treatments for opioid addiction – buprenorphine – can only be prescribed by doctors who have completed a special training and qualify for a Drug Enforcement Agency (DEA) waiver. Doctors who get the waiver can then treat up to 30 patients in their first year and up to 100 patients in subsequent years.
What strikes us as ironic is that any licensed doctor can prescribe highly-addictive opioids, like Oxycontin, fentanyl or morphine, without any limitation on the number of patients they treat. Buprenorphine is less addicting, less likely to be misused and has caused many fewer deaths than most commonly prescribed painkillers.
Why is buprenorphine singled out?
Fears about misuse led federal lawmakers to restrict its use. As an opioid, buprenorphine can be misused, but that is much less common compared to the misuse of other prescribed painkillers. Evidence suggests that when people use buprenorphine without a prescription, they are usually taking low doses to medicate their withdrawal symptoms from their primary drug of addiction (such as OxyContin or heroin) rather than taking large doses to get high. Also, one of the most commonly prescribed formulations of buprenorphine contains an abuse deterrent, naloxone, which diminishes the full effects of the medicine if the pill is crushed and injected or snorted.
The result of the special DEA waiver requirement is that there aren’t enough eligible physicians who have undergone training to receive the waiver. As of 2011, nearly half (43 percent) of U.S. counties had zero physicians qualified to prescribe buprenorphine. But that’s only half the problem: physicians who do have the waiver are prescribing to too few patients. Even if all physicians who currently have the DEA waiver treated the maximum number of allowed patients, approximately one million people would still be unable to get buprenorphine.
With the opioid addiction crisis across the nation reaching epidemic levels – 44 people die each day from overdoses involving prescription painkillers – changing these outdated federal laws is an important first step in combatting the crisis.
The good news is the federal government is starting to respond. In September, the U.S. Department of Health and Human Services announced it would change the rules for prescribing buprenorphine to expand access. While the details are still being worked out, the revised rules are expected to increase the number of patients that qualified doctors can treat. An important consideration is that all patients being prescribed medication for opioid addiction should also be receiving some form of counseling. Thus, doctors prescribing buprenorphine to more patients must either provide more counseling or refer their patient to someone who can.
Recently in a community forum in Charleston, West Virginia, President Obama called for increased access to buprenorphine and acknowledged that it is difficult to find addiction treatment. Permitting waivered physicians to prescribe buprenorphine to more patients won’t be enough to solve this problem. Other barriers will also need to be addressed. We need to ensure that waivered physicians are available in most U.S. counties, perhaps by making the waiver a requirement for all doctors who prescribe opioid pain killers, or by eliminating the waiver and instead incorporating buprenorphine prescribing into medical school curricula. In addition, the federal and state governments should pass laws to require health insurance companies to cover buprenorphine to help reduce the cost of this drug for patients and their families.
Fears of misuse of prescription drugs are valid, but they should not stymie efforts to treat individuals suffering from a deadly disease.
Mark Stovell is a freelance blogger for The National Center on Addiction and Substance Abuse