Few Patients Prescribed Buprenorphine for Opioid Addiction Misuse This Treatment - Everyday Health
Misuse of the anti-addiction drug buprenorphine is becoming less common as a growing number of U.S. patients who need this medication receive it to treat opioid use disorder, according to a study published in October 2021 in JAMA Network Open .
For the study, researchers examined data on 214,505 adults who participated in the 2015 to 2019 National Survey on Drug Use and Health, a group representative of an estimated 246.7 million adults each year. Despite increases in the number of patients receiving buprenorphine during the study period, the proportion of people with opioid use disorder who misused this medication declined from slightly over 20 percent in 2015 to just over 15 percent in 2019.
During the final year of the study, an estimated 2.4 million adults reported using buprenorphine over the past 12-month period. Just 29 percent of them lacked a prescription or used more than they were supposed to — the definition of misuse in the study.
Beyond this, the most common reasons survey respondents cited for misusing buprenorphine suggested that they might be doing this in an effort to fight opioid addiction.
Overall, 27 percent of them said they misused buprenorphine “because I am hooked” on opioids and 21 percent did this “to relieve physical pain,” indications that they might be using buprenorphine without a prescription to treat cravings and withdrawal symptoms associated with opioid use disorder, the study found.
“Concern about buprenorphine misuse is one of the factors that discourage clinicians from treating opioid use disorder with buprenorphine,” says senior study author Wilson M. Compton, MD, deputy director of the National Institute on Drug Abuse in Bethesda, Maryland.
But the study results suggest that prescribing buprenorphine might actually help reduce buprenorphine misuse, Dr. Compton says.
“Our results are consistent with the findings from multiple recent studies showing that people misuse buprenorphine to cope with symptoms of drug withdrawal and pain,” Compton says. “Receipt of drug use treatment helps reduce buprenorphine misuse.”
Self-Medicating to Treat Addiction
One study, published in 2014 in Drug and Alcohol Dependence , for example, looked at data on 106 patients who misused or abused buprenorphine to understand their motivations for doing so. The majority of them — 63 percent — said they were misusing buprenorphine in an effort to maintain abstinence from opioids, and only 4 percent of them said they abused buprenorphine in an effort to get high.
An earlier study, published in 2012 in Drug and Alcohol Dependence , examined data on 503 people with opioid use disorder to assess risk factors for buprenorphine misuse. This study found that patients were 7 times more likely to misuse buprenorphine when they sought out, but were unable to obtain this medication to treat their addiction.
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Buprenorphine is considered the gold standard for treating opioid use disorder because it helps reduce the surge of endorphins released in response to opioids, creating a less intense high, and also curbs withdrawal symptoms.
Many patients with opioid use disorder may use buprenorphine without a prescription or take more than directed by their doctor because this medication is far too difficult to obtain, says Bill Soares, MD, director of harm reduction services and an assistant professor of emergency medicine at the University of Massachusetts Chan Medical School, Baystate Campus, in Springfield.
Limited Access to Buprenorphine
In the United States, physicians must seek waivers from the federal government to prescribe buprenorphine, with strict limits on the total number of patients they can treat with the drug at one time.
Fewer than 1 in 10 primary care physicians get these waivers, according to a study published in April 2020 in the Annals of Internal Medicine . And, roughly 3 in 4 physicians who do receive waivers treat fewer than 30 patients with buprenorphine, this study found.
“Unfortunately, because of the stigma associated with addiction and burdensome regulations, we as medical providers, have restricted and underprescribed buprenorphine for patients with opioid use disorder,” says Dr. Soares, who wasn’t involved in the new study.
Often, doctors refuse to treat people with opioid use disorder unless these patients can prove their willingness to quit, Soares adds. Or doctors prescribe buprenorphine at doses that are too low or for durations that are too brief to effectively combat addiction.
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“Therefore, patients who wanted to use buprenorphine to treat their addiction were often forced to buy buprenorphine from others, or use their prescription differently than intended,” Soares says.
This wouldn’t happen if patients could easily get what they needed from their doctors, just like they can for other chronic medical conditions like high blood pressure or diabetes, Soares says.
“We have known for some time that buprenorphine is not typically a drug that is used by people with opioid use disorder for recreation, much like using insulin is not typically for recreation by people with diabetes,” Soares adds. “Helping our medical providers understand that opioid use disorder is similar to other chronic diseases, and that medication treatment is both safe and effective, will help to empower our patients to treat their own disease and decrease subsequent misuse.”