More doctors can prescribe leading addiction treatment. Why aren’t more people getting help?

by Carla K. Johnson

Credit: Unsplash/CC0 Public Domain

It’s easier than ever for doctors to prescribe a key drug for opioid addiction since the US government lifted a roadblock last year. But despite looser restrictions and the ongoing overdose crisis, a new study finds little change in the number of people taking the drug.

The researchers analyzed prescriptions filled by US pharmacies for the treatment drug buprenorphine. The number of prescribers increased last year after doctors no longer needed to get a special exemption to prescribe the drug, while the number of patients filling prescriptions barely increased.

It may take more than a year to see a larger increase in patients, said study co-author Dr. Kao-Ping Chua, of the University of Michigan Medical School.

“There are so many other barriers to prescribing that we need to address,” Chua said.

The findings were published on Wednesday at New England Journal of Medicine.

Buprenorphine, which helps with cravings, comes in a pill or film that dissolves under the tongue. It costs about $100 a month. A common version of buprenorphine is Suboxone. Nurse practitioners, assistants and doctors can prescribe it.

“People think that this is a very complicated medicine and that it requires some kind of complex knowledge to use, when that’s not the case,” said Dr. Ryan Marino of the Case Western Reserve University School of Medicine in Cleveland, who has treated hundreds of people. with buprenorphine. He had no role in the study.

Barriers include insurance hurdles, price, pharmacies that don’t stock the drug and doctors who believe it takes up too much of patients’ time with addiction, Chua and other experts said.

“There is a lot of stigma about this drug and generally about patients with opioid addiction,” Chua said.

Also, some people may not want to try buprenorphine, Chua said. They may think they can’t really recover if they use opioid-based medication, he said. And it can cause withdrawal symptoms, especially in people who have been using fentanyl, the powerful opioid that now dominates the drug supply.

The researchers used a database that captures 92% of filled prescriptions. Comparing 2022 and 2023, before and after the exemption was removed, they found 53,600 prescribers at the end of 2023, up 27% from a year earlier. The number of people filling prescriptions rose about 2% to about 845,000.

The government should look for ways to encourage and even compel hospitals and health systems to offer more treatment, said Brendan Saloner, an addiction researcher at the Johns Hopkins Bloomberg School of Public Health, who was not involved. in the study

More doctors are prescribing buprenorphine, but “getting most of the medical profession to catch up is taking too long,” Saloner said.

More information:
Dispensing Buprenorphine After Removal of Exemption Requirement, New England Journal of Medicine (2024). DOI: 10.1056/NEJMc2312906.

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