To Deregulate or Not? Addiction Experts Grapple with Who Can Prescribe Buprenorphine

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Opioid Epidemic

Nearly all Americans can agree that the opioid epidemic is a public health crisis.

Most can agree that medication-assisted treatment is a viable solution to help mitigate the opioid epidemic.

How can medication-assisted treatment be optimally delivered to effectively solve the health problem? The devil’s in the details.

Right now there’s a dissent among opioid policy and medical experts on if it makes sense to deregulate buprenorphine, a FDA-approved medication used to treat opioid use disorder.

There are two schools of thought. One side supports deregulating buprenorphine, thus making it easier for clinicians to prescribe the medication. The other side maintains that prescribing buprenorphine should be regulated to federally-credentialed opioid treatment providers that offer not only the treatment medication, but also other support services like counseling and therapy. 

To Deregulate

Two acclaimed doctors with extensive experience in addiction medicine recently published an article that supports the deregulation of buprenorphine prescribing, arguing that doing so would save more lives of those with opioid use disorder.

The authors write, “one possible solution to this terrible epidemic is hidden in plain sight: remove governmental restrictions on prescribing buprenorphine to treat addiction.”

The article explains what a clinician must undergo to prescribe buprenorphine: receive additional training (anywhere from an 8- to 24-hour training session), get a special license, and allow Drug Enforcement Administration agents to review their patient records.

This governmental oversight, they argue, precludes more than 93% of physicians in the U.S. from being authorized to prescribe buprenorphine.

The deregulation of buprenorphine, the authors say, would help in three key ways:

  • Deregulation would eliminate the extra steps — like training, licensure and audits — needed for clinicians to prescribe the medication.
  • It would be easier for patients to find prescribers, since any physician, nurse practitioner or physician assistant could prescribe buprenorphine. 
  • Deregulation may help remove the stigma from treating patients with opioid use disorder, sending “a powerful signal to the medical community and patients that opioid use disorder is no different than diabetes or other chronic health problems.”

The article concludes by stating, “We are puzzled why Congress has yet to take these simple steps to help end the opioid overdose epidemic.”

Perhaps this is why…

To Regulate

The other school of thought, championed by one of the nation’s leading organizations for opioid forethought and policy — the American Association for the Treatment of Opioid Dependence (AATOD) — issued a competing policy paper that supports the status quo, or limiting the prescription of buprenorphine to the clinicians who conform to the governmental oversight.

“It is important to keep in mind that we are treating a complex disease, which also needs the benefit of clinical support and an organized system of care,” Mark Parrino, President of AATOD, said.

Years of evidence and clinical practice prove that buprenorphine should follow regulatory oversight for many reasons, including these:

  • Buprenorphine diversion, or overdose that occurs when the medication is used with benzodiazepine, alcohol, or other drug combinations, could become more prevalent if physicians not well versed in addiction are authorized to prescribe the medication.
  • Buprenorphine administered at OTPs offers a dynamic approach to treatment, including counseling, therapy and life services support. Primary care practitioners may not have the resources to provide this whole-patient care.
  • General healthcare providers have been said to over prescribe painkillers, in part leading to the opioid crisis now facing the nation. Does it make good sense to trust them to solve the problem they may have helped to originate? 

Regardless, then how do we solve this health epidemic? 

There’s a solution, Parrino said. “One way to provide increased access to treatment is to open more comprehensive opioid treatment programs throughout the U.S., especially focusing on underserved areas.” 

Privately-held organizations own and operate the 1,600 OTPs in the U.S., which represents a growth in treatment centers over the last 10 years. Treatment is not homogeneously dispersed across the nation, however. Wyoming does not have any OTPs. Mississippi has four. 

“The federal government and states need to provide investments to open new treatment programs.” Parrino advised. “Zoning boards and community opposition to OTPs is the real hinderance, which is why we need a national education campaign about why effective treatment centers are needed to save lives.”

Bottom line, there are 2.1 million Americans battling opioid use disorder, and only a fraction of those affected — approximately 17.5% — are receiving treatment, all the while the disease is claiming 130 lives per day. The team at New Season is working tirelessly to help those who have been afflicted by this grueling disease.

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