July 21, 2016

As part of a multi-pronged effort to address the growing opioid addiction epidemic in the United States, the Department of Health and Human Services announced last week that it would make one treatment medication more accessible.

With addiction to opioids such as heroin and pain medication like Oxycontin on the rise, buprenorphine stands as the top medication for opioid addiction treatment in the country, according to The Washington Post. Following HHS’s announcement, buprenorphine prescriptions will now be available to nearly three times the amount of patients than in the past.

A relatively new drug on the scene of addiction treatment since it was approved by the FDA in 2002, buprenorphine has been limited because it is an opioid itself. Until now, each health care provider had only been able to prescribe the medication to 100 patients at a single time. Addiction specialists and advocates believe that such restrictions were limiting access among opioid-dependent individuals who might otherwise benefit from buprenorphine. Due to the HHS decision, providers can now prescribe the medication up to 275 patients.

Stephen Lankenau, PhD, professor of Community Health and Prevention in the Dornsife School of Public Health, specializes in the research of prescription drug misuse and overdose prevention. He explained the appeal of treatment with buprenorphine and why expanding access to it is a good thing.

First, do you feel that the misuse of opioids is a substantial public health crisis in the United States?

The U.S. is in the midst of an unprecedented opioid epidemic. Each day, an average of 78 Americans die of an opioid overdose — a rate that’s higher than any period on record. In Philadelphia, almost 700 drug overdose deaths were reported in 2015 — twice as many as deaths from homicide. Many of these overdose deaths were attributed to the use of heroin or prescription opioids.

Nationally, the rate of overdose deaths involving opioids — including pain medications and heroin — has nearly quadrupled since 1999. Additionally, in 2014, there was a sharp increase in heroin-involved deaths and an increase in deaths involving synthetic opioids such as fentanyl.

Do you think buprenorphine treatments are a Band-Aid for this epidemic, or are they crucial for recovery?

For many opioid-dependent persons who may have misused prescription opioids and/or heroin for an extended period of time, complete opioid detoxification is not a viable option. For these individuals, treatment with buprenorphine is an important part of recovery.

Buprenorphine works as a partial opioid agonist, meaning it activates the opioid receptors in the brain, but to a much lesser degree than a full agonist, such as methadone. Hence, buprenorphine does not produce the “high” of full agonists.

Additionally, buprenorphine also works as an opioid antagonist, meaning it blocks other opioids — such as heroin — while suppressing withdrawal symptoms and cravings. When taken as directed under a doctor’s supervision, the risk for drug overdose is very small.

Can buprenorphine treatment be effective in an overdose prevention program?

In my research, persons who have recently suffered an opioid overdose are rarely on a prescribed buprenorphine regime or in any kind of current drug treatment. Rather, they are often active users of heroin, prescription opioids and/or prescription tranquilizers

Prevention Point Philadelphia provides overdose prevention training, including the use of naloxone, which can reverse an opioid overdose. They also offer a buprenorphine program for interested clients. So, distributing naloxone in combination with offering buprenorphine treatment is an effective system that may reduce the likelihood of drug overdoses.

Would buprenorphine prescription help everyone struggling with addiction equally, or are there certain groups who would benefit more?

Methadone has been the primary drug to treat opioid dependence since the 1960s. But since buprenorphine was approved in 2002, research has focused on determining whether there are benefits to prescribing buprenorphine over methadone.

One difference between the two treatments, which are administered daily, is that buprenorphine is a take-home medication whereas methadone is commonly administered in a clinic.

While research is ongoing, buprenorphine is proving to be as effective as methadone with a lower risk of overdose. Hence, buprenorphine is likely to benefit most anyone suffering from opioid dependence.