by A new study shows that reducing restrictions on buprenorphine, a drug that can treat opioid use disorder, does not result in an increase in overdose deaths involving treatment. The findings may help address concerns that the greater availability of buprenorphine could lead to more overdose deaths.
Buprenorphine and similar drugs such as methadone and Suboxone are opioid agonists that reduce withdrawal symptoms and cravings. Compared to methadone, buprenorphine has a lower potential for misuse and overdose, making it the most accessible of all options, but the study says it’s “largely underused.”
There are restrictions on who can prescribe buprenorphine and where it can be obtained. It continues to be classified as a Schedule III controlled substance, meaning a substance with a moderate to low risk of addiction. Previously, buprenorphine had to be prescribed in a clinical setting by a prescriber registered with the Drug Enforcement Administration. Recent policy changes have removed the requirement, commonly known as the “X exemption,” that limits how many patients a provider can prescribe buprenorphine.
During the coronavirus pandemic, federal rule changes require qualified clinicians remote prescription buprenorphine eliminates the need for face-to-face evaluation, even for new patients. This change will remain in effect until the federal government ends the public health emergency declared in April 2020.
To determine the impact of these policy changes, the federal researchers who conducted the study looked at 89,111 overdose deaths reported by 32 jurisdictions from July 2019, before the changes began, to June 2021, approximately 15 months after the new policy. Of these 89,111 overdose deaths, 74,474 involved opioids.
Only 1,995 of opioid-related deaths involved buprenorphine. In total, buprenorphine was found in 2.2% of all drug overdose deaths and 2.6% of opioid-related overdose deaths.
despite the increase overdose deaths Buprenorphine overdose deaths did not increase from 2019 to 2021. The researchers found that there was some fluctuation between July 2019 and June 2021, but death rates either decreased or remained stable.
“Our findings suggest that extended prescribing is not associated with a disproportionate number of deaths involving buprenorphine,” the researchers said in the study, a joint effort between the National Institute on Drug Abuse and the Centers for Disease Control and Prevention.
However, although rare, deaths from overdose involving buprenorphine highlight the importance of overdose prevention and support for those using buprenorphine, both under medical supervision and outside of SUD treatment. [substance use disorder] or pain,” they wrote.
The researchers also said fairer access to drugs and other “harm reduction strategies” is needed to help tackle the overdose crisis.
Another finding of the study was that less than a quarter of the overdose deaths caused by buprenorphine were people who were being treated for opioid use disorder at the time of death, and even fewer – about 20% – used medication specifically to help the problem.
At the time, only 3.2% of people who died of opioid overdoses were receiving treatment.
This “conclusive finding” “highlights the need to expand access to evidence-based treatment, specifically drugs for OCD, improve treatment maintenance, and support long-term recovery,” the researchers said.
A big part of buprenorphine being subject to restrictions is the concern that it might be “directed” or given to someone else by the person receiving the prescription. The study looked at this issue and found that while there was some abuse, this was likely due to people trying to “suppress withdrawal” and “self-medicate” their addictions in the absence of access to formal treatment. concluded that it was unlikely that they would abuse it.
The researchers said their findings are consistent with a 2022 study that reported no association between flexibility in prescribing methadone-based therapy during the COVID era and methadone-related overdose deaths. In most cases, patients using methadone have to go to clinics daily for their doses, but during the pandemic, patients were allowed to supply the medication for up to one month at a time.
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