A potentially lifesaving drug that reduces overdose risk is prescribed to less than half of Americans treated for opioid addiction, a new study finds.
This underuse of buprenorphine is "equivalent to giving those with advanced cancer a less aggressive treatment," said senior investigator Dr. Laura Bierut. She is a professor of psychiatry at Washington University School of Medicine in St. Louis.
"It seems obvious to many of us that we should be giving the most aggressive and effective treatments to those who are most seriously ill," Bierut added in a university news release.
For the study, Bierut and her colleagues analyzed health insurance data on about 180,000 people nationwide treated for opioid use disorder from 2011 to 2016. Only 47% of them were prescribed buprenorphine, and the rate was even lower (about 30%) for opioid users who also misuse other substances such as alcohol, methamphetamine, benzodiazepines or cocaine.
The study was published online May 10 in JAMA Network Open.
"It's concerning that the majority of people misusing multiple substances don't appear to be getting the lifesaving medication they really need," said study co-author Dr. Kevin Xu, a resident physician in the university's psychiatry department.
"While the data we analyzed predates COVID-19, the pandemic saw an escalation in overdoses, yet we're still not seeing many eligible patients get buprenorphine prescriptions," Xu noted.
The data the researchers analyzed are a few years old, Bierut said. "But we think this information can be extrapolated to what's happening now because even more people using opioids — or using opioids as well as other substances — are showing up in emergency departments today. The problem has only gotten worse during the COVID-19 pandemic," she added.
Nearly 107,000 people in the United States died of drug overdoses from early 2021 through early 2022, compared with 70,237 drug overdose deaths in 2017, according to the U.S. Centers for Disease Control and Prevention.
There are a number of possible reasons for the low rate of buprenorphine prescriptions among people treated for opioid addiction, according to Xu.
Buprenorphine itself is an opioid, which may make doctors hesitant to prescribe it to people with opioid addiction. Buprenorphine can be taken at home and does not require daily trips to a clinic, but that lack of supervision could also affect decisions about prescribing it. Another reason may be insufficient data about the drug's effectiveness in those who misuse multiple substances.
But such concerns appear to be unfounded, Xu said.
"Buprenorphine appears to be a safe opioid," he noted. "It's specifically designed to be different from other opioid drugs in that it won't cause a user to stop breathing, which pretty much every other type of opioid will do. That means it can be taken safely at home, which is very helpful, even essential, to recovery."
There's more on opioid addiction at the American Academy of Family Physicians.
SOURCE: Washington University School of Medicine, news release, May 10, 2022