Buprenorphine has shown to be effective and has the potential for widespread use to address the opioid epidemic. A subset of individuals with OUD have been acquiring it without a prescription.
In a recently published observational retrospective analysis, investigators were intrigued when they analyzed the data collected from a large multi-state nationwide opioid treatment program for opioid use disorder (OUD).
Among the population of individuals with the disorder who entered the program, there was a subset that had already been using buprenorphine without obtaining a prescription for it. The medication is highly effective in reducing opioid use, overdose and mortality, and investigators found that this was an indicator of treatment readiness.
According to investigator Stephen Crystal, PhD, Director of the Center for Health Services Research at the Rutgers Institute for Health, Health Care Policy and Aging Research, Distinguished Research Professor, Rutgers School of Social Work, buprenorphine is, unfortunately, underutilized despite its evidence to improve the quality of life of those who live with OUD.
"When we look at the data on people who've been diagnosed with opioid use disorder, only a small minority–still–receive this treatment," Crystal said. "Buprenorphine has a lot of potential for widespread use, more than methadone."
While methodone has been a long-standing therapy for opioid use disorder, it requires the individual to be in the clinic, and when starting treatment, they have to come in 6 days a week. Not only does this complicate the likelihood of adherence, but it's difficult for organizations to open new clinics.
"We need to be taking a much more aggressive approach to engaging everyone who is presenting themselves to the healthcare system in one touch point or another to initiate treatment," Crystal said.
The opioid epidemic continues to be a public health concern in the US. In 2020, the amount of fatal opioid overdoses increased to 107,000.
"Because of all these barriers, people find it easier and quicker to access [buprenorphine] treatment on the street," he said. "We'd much rather see them coming in immediately to formal treatment."
The investigators were surprised to see the strong association with treatment retention among the individuals who acquired buprenorphine without a prescription compared with those who hadn't. Opioid use disorder is a chronic relapsing conditon where there are moments of opportunity.
According to Crystal, this study shouldn't lead to the perception that some people aren't ready for treatment while others are, but that some people may need more support.
"We have wonderful examples in New Jersey where some emergency medical systems, under the authority of their EMS director, are initiating buprenorphine in the field for people experiencing overdoses," he explained.
Crystal emphasized that the discussion surrounding the magagement of pain and opioid use disorder needs to focus less on restrictions for prescribing physicians and more on what can be done to help those who are struggling with pain and addiction right now.