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Understanding reasons behind underutilization of drugs approved for opioid addiction treatment

Understanding reasons behind underutilization of drugs approved for opioid addiction treatment

10-12 | CDAH Team

Opioid abuse and addiction is a serious global problem that negatively affects people’s health and damages the socio-economic fabric of the society. In 2014, nearly 2 million Americans were estimated to be dependent or to have abused prescription opioids. Apparently, the increase in the rate of prescription drug abuse has been primarily attributed to increased practice of overprescription of opioids by medical practitioners.

The number of unintentional overdose deaths due to opioids has more than quadrupled since 1999 in the United States. There were over 183,000 deaths between 1999 and 2015 due to prescription opioids. The situation forced President Donald Trump to declare the opioid epidemic a national emergency in August 2017.

Looking at the ongoing opioid crisis, medical practitioners need to scale down prescribing certain drugs like buprenorphine and methadone approved for the treatment of opioid addiction. With a number of legal restraints imposed for dispensing these drugs, the entire goal of increasing the number of patients receiving treatment now stands defeated.

Lack of expertise and resources keep physicians away from prescribing drugs for opioid addiction

Under federal law, methadone must be dispensed from authorized clinics. However, buprenorphine is approved for the treatment of opioid addiction from a physician’s chamber in a primary care setting, so long as he or she has obtained proper waivers.

In 2002, buprenorphine was approved for the treatment of OUD, with the condition that physicians obtain a waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA) to prescribe the drug under such settings. Compared to methadone, it is relatively less intense and help adequately manage withdrawal symptoms. Therefore, it is less likely to be abused. A physician can treat just 75 patients in the first year, which subsequently increases to 275.

The belief that allowing physicians to prescribe the drug in a primary care setting would enable more patients to receive treatment has not materialized. A study conducted to understand the reasons behind the underutilization of drugs effective against opioid addiction was conducted on 558 English-speaking physicians in the U.S. during the spring and summer of 2016.  Some of them possessed the waiver to prescribe buprenorphine while others did not. The questions of the survey were related to the loopholes in the prescription of buprenorphine and steps that will motivate both physicians with waivers and those without waivers.  It’s interesting to note that only 74 respondents suggested of not possessing waivers to prescribe the drug. Among these physicians, one-third of this respondents indicated that nothing would encourage them to get a waiver. This is mainly to avoid inundation of patient requests for buprenorphine (29.7 percent) and concerns related to selling of such medications for recreational purposes (25.7 percent)

Those who had obtained the waiver accounted for more than 50 percent of the respondents. Despite such a large proportion of the physicians with the waiver, the drugs are not prescribed to their capacity. Even the physicians with waivers expressed reluctance to increase the prescription rate of the drugs approved for the treatment of opioid addiction. They expressed that they would not increase their prescribing patterns at any cost. Among them, 36 percent cited the reason as having no time to spare for more patients and 15.4 percent cited the reason as insufficient reimbursement.

At the end, both the sets of respondents expressed their willingness to obtain waiver and dispense medicines to capacity. They were ready to embrace change on being provided information about the local counseling services, paired with an experienced provider and offered more continuing medical education (CME) courses on opioid disorder.

Better medical education can help combat opioid crisis

Traditionally, psychiatrists have always held the supreme position in addiction treatment. Therefore, medical practitioners working in primary setting would require supervision and hands-on training to learn the nuances of treatment for substance abuse, especially opioids. This will significantly improve the diagnosis process. Moreover, medical schools and residency programs should include addiction treatment as a part of their curriculum or CME programs.

If you or your loved one is struggling with substance abuse problem, connect to the Colorado Drug Addiction Helpline to contact the best addiction treatment centers in Colorado specializing in the best evidence-based intervention plans. Call at our 24/7 helpline number 866-218-7546 or chat online for further information on addiction treatment in Colorado.


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