Stephen Crystal, PhD: Buprenorphine Use Prior to Treatment Linked with Better Outcomes

When focusing on the population of individuals who live with opioid use disorder (OUD), there's a subset of them who seek out buprenorphine without obtaining a prescription for it. The medication is highly effective in reducing opioid use, overdose and mortality, however, it's also a highly underutilized treatment for the disorder, and access to it in medical settings is limited.

Because buprenorphine can also greatly help to improve individuals quality of life while reducing their opioid use, a team of investigators decided to study this population for markers of readiness for addiction treatment.

The observational retrospective analysis was collected from a large multi-state nationwide opioid treatment program and throughout the research process, investigators became particularly fascinated by what they were reading in the patient intake notes, according to one of the authors.

Stephen Crystal, PhD, joined HCPLive for an interview to discuss his team's findings. He serves as the director of the Center for Health Services Research at the Rutgers Institute for Health, Health Care Policy and Aging Research, and is a Distinguished Research Professor at the Rutgers School of Social Work.

"More than half of these patients who were coming into formal treatment for the first time with buprenorphine, were actually already testing positive for the for the drug," Crystal said.

Many of the notes detailed that patients disclosed that they were getting buprenorphine from the street in order to manage their withdrawal symptoms before they came in for treatment.

Crystal found this extremely interesting.

He explained that buprenorphine serves as a partial opioid blocker that is very effective in helping to reduce the harms of opioid use disorder, facilitate recovery and help patients lead a functional life.

"The partial blockade, if it's dosed properly, will block the high from other medications, from other opioids that people have gotten used to using to get high with, and it will reduce cravings," Crystal said. "It's much more of a steady state. It doesn't fully block the opioid receptor but it blocks it enough to block the effects of other medications without giving the same kind of extreme highs."

Crystal said that after reviewing the relationship between this subset of patients who began treatment already on buprenorphine and the positive clinical outcomes of the treatment program, it makes sense.

"The people who had selected themselves and had gotten used to the experience of being on a partial blocker, retained in treatment better, and were better able to remain in treatment without using other street opioids," he said.

"But, we believe that it has a lot of implications for the widespread concern about buprenorphine diversion," Crystal continued. "The issue of buprenorphine diversion has sort of been used as a reason for this very highly regulated, highly bureaucratized system that we have with special DEA licenses and X waivers to prescribe buprenorphine."

In the next segment of his interview with HCPLive, Crystal goes into detail about the limitations surrounding buprenorphine and the role these regulations play in the overall treatment of opioid use disorder.