The old saying goes that you have to fight fire with fire.
Using that logic, health officials have increased the availability of an opioid to combat the rising tide of opiate addiction.
On any given day, according to the U.S. Centers for Disease Control and Prevention (CDC), 650,000 opioid prescriptions are dispensed.
Image source: commons.wikimedia.org/wiki/File:Suboxone_SL_Tabs.jpg
Of these, 3,900 people begin using the drugs for nonmedical reasons, and 78 people die from an opioid-related overdose. That’s every day.
In western Pennsylvania, for instance, deaths caused by opioids, including heroin and prescription drugs, increased by more than a third last year, according to a new report from the Drug Enforcement Agency (DEA).
In an effort to address the opioid epidemic, the White House has requested $1.1 billion to help people get treatment near where they live.
This includes expanding the number of physicians who can prescribe an opioid that’s used to treat opioid addiction when administered in large doses.
Expanding access to buprenorphine
Major studies have found people who use drug-assisted therapy, such as buprenorphine or methadone, have a much higher success rate of finally ridding themselves of their addiction.
Coupled with group behavioral therapy, that rate increases.
“The studies that have come out have shown this is most effective for opioid addiction,” Dr. Doug Nemecek, chief medical officer of Cigna Behavioral Health, told Healthline.
Research has shown that without medical intervention, addicts have a 90 percent relapse rate.
“It’s a really terrible addiction,” Stephen A. Wyatt, D.O., medical director of addiction medicine and behavioral health at Carolinas HealthCare System in North Carolina, told Healthline.
Earlier this month, the Department of Health and Human Services (HHS) changed its rules to allow individual physicians to personally oversee the use of buprenorphine for 275 patients at a time. The doctors must be federally certified to prescribe the drug.
The move reflects a better understanding of addiction and the underpinnings behind it. It’s not, as once widely believed, a matter of weak character, but a mental and physical condition that can be all-consuming and, all too often, fatal.
Previously, a doctor was only allowed to prescribe buprenorphine to 100 patients. Before the last rule change in 2006, a physician could prescribe the drug to only 30 patients.
Buprenorphine is on the market under different names and formulations, the most common is Suboxone, which is administered in a dissolving strip. It’s formulated as a combination of buprenorphine and naloxone, a drug used to prevent fatal opioid overdoses.
Buprenorphine is used as a long-term treatment for opioid addiction. Its euphoric effects are milder than opioid medications and heroin, although the same parts of the brain are activated. And naloxone is far less likely to be fatal if injected.
While overdoses are less likely, they do occur, namely when taken with other drugs or alcohol.
And like other drug subcultures, Suboxone has turned into a cash-only drug market, smuggled into prisons, and distributed by doctors with questionable, and sometimes criminal, prescribing practices, according to a New York Times investigation.
Allowing doctors to legally prescribe buprenorphine to more patients has some people hopeful it will cut down on these shady, back alley practices. Still, others say the 275-patient limit isn’t enough.
“There’s certainly a number of people who believe having a set number restricts practice,” Wyatt said.
This was the case when the new rule was proposed and open to comments. Many addiction specialists noted that while there are restrictions on how many patients a doctor can prescribe buprenorphine, there isn’t a restriction on how many prescription opioids they can dole out.
To use the fire analogy again, that’s like restricting water supply to firefighters during a wildfire.
A treatment with fewer stigmas
While there are concerns, the increased access to buprenorphine does have its advantages, namely the ability to bring drug treatment inside a doctor’s office.
Getting medication from a doctor, instead of visiting a methadone clinic, may help addicts overcome the stigma associated with opioid addiction.
“Because of the stigma of methadone clinics, they thought they were different than heroin addicts living on the streets,” Nemecek said, “but as an illness, there’s no difference between someone who is addicted to Percocet or oxycodone than individuals addicted to heroin.”
Besides stigma, relapses on methadone clinic-based treatments are about as common as nonmedical interventions.
The issue of opioid addiction gained increased attention, not just as rates skyrocketed, but also as heroin became more common in affluent communities, specifically predominantly white, higher-income suburbs.
“It’s now becoming evenly spread across races,” Wyatt said.
While buprenorphine alone is far from a cure-all, it is a tool doctors have to combat opioid addiction epidemic in the United States.
Still, access and increasing Medicare and Medicaid spending to fund the programs to ensure addicts are getting sufficient care continue to be an issue, Wyatt said.
“Are we really moving them forward in terms of their addiction?” he said. “We need to show the public this good treatment.”