In the year 2012, physicians wrote out over 259 million prescriptions for opioid pain killers. This staggering number is enough to provide one prescription to every adult in the country.
At the same time that doctors are prescribing more and more opioids, opioid addiction and misuse has reached epidemic proportions. Deaths due to opioid overdose have surpassed even those due to motor vehicle accidents. In 2014 alone, opioids killed more than 28,000 people.
As it turns out, opioids are surprisingly easy to prescribe, which may explain their growing prevalence.
Drugs that treat opioid addiction, meanwhile, often undergo harsh restrictions that keep them out of the hands of the people that need them most. Buprenorphine is just one example.
What is buprenorphine?
Buprenorphine is a medication that can be used to treat opioid addiction.
Buprenorphine – like morphine and heroin – engages the opioid receptors in the brain. Unlike morphine and heroin, however, buprenorphine is not a full opioid agonist but a partial opioid agonist, meaning that its effects are not as strong. This means that individuals who are addicted to opioids can take buprenorphine to reduce cravings and withdrawal symptoms, but are unlikely to overdose or experience severe ill effects.
In 2002, buprenorphine was approved by the FDA as a treatment for opioid addiction. Since its approval, however, it has remained underutilized. In 2015, researchers reviewed the history of medication-assisted treatment for opioid addiction and found significant treatment gaps between those who would benefit from these medications and those who receive them.
Why doctors do hesitate to prescribe buprenorphine?
Doctors aren’t avoiding buprenorphine prescriptions because the drug is ineffective or expensive. According to Jeffrey Hom and Krisda H. Chaiyachati, two physicians at the University of Pennsylvania, physicians largely avoid prescribing buprenorphine because the regulations associated with it are so immense.
“Physicians must first complete buprenorphine-specific training and receive a waiver from the DEA,” they write in an editorial. “Once certified, they must maintain strict logs pertaining to treatment. They are allowed to treat no more than 100 patients with buprenorphine at a time.”
The reasoning behind these regulations is that buprenorphine can be addictive, much like other opioids. Surprisingly, however, most other opioids have less restrictive prescription requirements – even though they contain the same abuse potential, if not more.
“As physicians, we need to obtain only a license from the Drug Enforcement Agency (DEA) in order to prescribe opioid painkillers,” they write. “Maintaining it requires a licensing fee every three years, but there is no mandatory training on how to safely prescribe these medications and no requirements to monitor patients who receive them. There is, in short, little oversight.”
Something else Hom and Chaiyachati note is that nurse practitioners and physician assistants – two groups of professionals who receive similar training as doctors and often practice autonomously – are not permitted to prescribe buprenorphine no matter the circumstance.
These clinicians can, however, prescribe opioid pain killers.
“This is particularly problematic because these ‘physician extenders’ provide a significant proportion of health care in rural areas, which are often hit hardest by the epidemic,” write Hom and Chaiyachati.
Change is necessary
Opioid abuse is not a niche issue – it affects us all. A car accident, a sports injury, or even chronic back pain can easily fill our medicine cabinets with opioid pain relievers. If we ever get hooked on these drugs, however, few physicians can prescribe what has been described as a life-saving drug for addiction treatment.
It’s always important to be wary about using a potentially addictive drug. Buprenorphine CAN be addictive. It can also save a person’s life and help them achieve sobriety. Hopefully, someday buprenorphine will be prescribed as easily as it is to receive than the painkillers that are directly involved in the opioid epidemic.
Sovereign Health’s addiction treatment program offers comprehensive treatment for adolescents who are addicted to substances, including alcohol, opiates, cocaine and amphetamines. We do more than help our patients through withdrawal – we also provide therapy and restorative activities to educate our clients as well as to prevent relapse. For more information, contact our 24/7 helpline.
About the author
Courtney Lopresti, M.S., is a senior staff writer for Sovereign Health, where she uses her scientific background to write online blogs and articles for a general audience. At the University of Pittsburgh, where she earned her master’s in neuroscience, she used functional neuroimaging to study how the human cerebellum contributes to language processing. In her spare time, she writes fiction, reads Oliver Sacks and spends time with her two cats and bird. Courtney is currently located in Minneapolis. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.