Number of Doctors Prescribing Buprenorphine Up Dramatically
Buprenorphine is recognized by the U.S. Food and Drug Administration as an effective treatment for people addicted to powerful opioid street drugs or medications. However, doctors must receive permission before prescribing buprenorphine, and the distribution of approved physicians throughout the U.S. is uneven. In a study published in June 2015 in the journal Health Affairs, researchers from several U.S. institutions tracked access to buprenorphine treatment over the first decade-plus of the 21st century.
Buprenorphine is an opioid substance with most of the same chemical properties as powerful opioid painkillers such as hydrocodone and oxycodone, as well as heroin and other opioid street drugs. Just like these substances, which unfortunately act as sources of opioid addiction with some frequency, buprenorphine travels through the bloodstream to the brain, where it produces euphoria in the pleasure center and slows down the baseline rate of cell activity. However, buprenorphine is substantially weaker than the opioid substances that typically function as targets for addictive use. When given to a person withdrawing from strong opioids, the medication does not typically promote a continuing pattern of uncontrolled substance intake. Instead, buprenorphine acts as an effective short-term treatment for opioid withdrawal symptoms or as a safer, long-term replacement for stronger opioid drugs or medications.
Since buprenorphine is an opioid, it can still promote uncontrolled substance intake in people not used to opioid substances. In addition, people accustomed to more powerful opioids may attempt to misuse the medication in order to experience their desired drug effects. Pharmaceutical manufacturers address these issues by adding another medication, called naloxone, to buprenorphine-based products. When present in certain amounts, naloxone essentially imposes a time limit on buprenorphine’s opioid effect, and thereby substantially reduces buprenorphine’s appeal outside of a medically appropriate context.
Doctors and Buprenorphine Access
Unlike another opioid-based medication called methadone, buprenorphine can be prescribed by doctors not located at federally approved treatment clinics. However, the U.S. Drug Enforcement Administration (DEA) still requires all physicians who wish to issue the medication to their patients to apply for a waiver granting them access to buprenorphine. Before qualifying for a waiver, a physician must meet a number of requirements, including holding a license or certificate from one of three national boards of medical certification, undergoing training on the treatment for opioid addiction and meeting state-level standards for providing opioid addiction treatment.
How Common Is Access to the Medication?
When buprenorphine entered the market in 2002, most of the doctors eligible for a DEA waiver lived in cities or metropolitan areas. Unfortunately, this meant that large numbers of opioid-addicted Americans living in less populated areas had limited or no access to the medication and had to rely on other, potentially less helpful modes of opioid treatment. In the study published in Health Affairs, researchers from the RAND Corporation, the University of Pittsburgh School of Medicine, the Veterans Affairs Pittsburgh Healthcare System and the Penn State College of Medicine used information supplied by the federal Substance Abuse and Mental Health Services Administration to track the changing distribution of American doctors with DEA approval for buprenorphine prescribing between 2002 and 2011.
The researchers found that, in 2002 when buprenorphine prescribing was in its infancy, fully 98.9 percent of all U.S. counties had too few approved doctors to meet the needs of their opioid-using populations. The counties in question included roughly 49 percent of all Americans. At the end of 2011, just 46.8 percent of all U.S. counties had too few doctors with DEA approval for buprenorphine prescribing. By this point in time, the counties in question included only 10 percent of all Americans. Overall, nationwide access to buprenorphine-based opioid addiction treatment has increased by about 74 percent in a single decade.
The study’s authors note that the dramatic increases in buprenorphine availability have widely added to the range of effective treatment options for doctors who treat opioid-addicted patients. They also note a need for even further increases in the medication’s availability as part of an ongoing effort to reach underserved segments of the population.