Doctors Increasing Use of Buprenorphine in Addiction Treatment
The use of buprenorphine to treat opioid dependence has increased dramatically in the last 10 years, particularly among general physicians, indicating a clear shift in opioid maintenance therapy in the United States, a new study finds.
Buprenorphine is a modern opioid medication designed to, among other things, help people affected by opioid addiction break a pattern of uncontrolled drug or medication consumption and stay active in their treatment programs. All licensed doctors can prescribe buprenorphine to their patients; however, doctors who don’t specialize in addiction treatment once largely avoided prescribing the medication. In a study published in late 2014 in The American Journal on Addictions, a team of American researchers looked at the long-term trend of buprenorphine prescribing in outpatient addiction treatment among all U.S. doctors, including psychiatrists and general physicians.
Treating Opioid Addiction
All opioid treatment programs help their clients/patients halt the unrestrained intake of opioid drugs like heroin or opioid medications such as hydrocodone and oxycodone. In many cases, the first step toward this goal is detoxification, a period in which opioid intake stops and the individual gradually purges all opioids from his or her system. In detox-based programs, this period is followed by the establishment of opioid abstinence and the use of non-opioid medication and counseling or therapy to reinforce abstinence and provide the tools necessary to avoid a return to opioid use.
A second approach, widely known as opioid replacement therapy or opioid maintenance therapy, does not aim to completely eliminate opioids from the systems of program participants. Instead, this approach relies on the controlled use of opioid medications as a substitute for the uncontrolled intake of opioid drugs or medications. In some cases, opioid replacement is used as a short-term tool to help people in recovery avoid grappling with the most severe consequences of opioid withdrawal. In other cases, opioid replacement continues for weeks, months or years and provides clients/patients with an ongoing substitute for uncontrolled opioid use. As a rule, opioid replacement therapy also has a substantial counseling or psychotherapeutic component.
At one time, all opioid maintenance programs featured an opioid medication called methadone. However, doctors can now use buprenorphine instead of methadone. Buprenorphine has several potential advantages over methadone. First, a dose of buprenorphine is substantially weaker than a dose of methadone and therefore comes with lower risks for abusive use during opioid treatment. Unlike methadone, buprenorphine also has a relatively low ceiling of maximum potency when taken improperly in multiple doses. Pharmaceutical manufacturers can further reduce the abuse risks for buprenorphine by combining the medication with naloxone, a second medication that puts a firm time limit on the biological availability of buprenorphine’s opioid content. Finally, methadone prescription is limited to certain facilities with special federal licensing; however, even a general physician not dedicated to addiction treatment can prescribe buprenorphine.
Are Doctors Prescribing More Buprenorphine?
In the study published in The American Journal on Addictions, researchers from Johns Hopkins University, the University of Illinois at Chicago and a private medical practice in Harrisburg, Pennsylvania, used data gathered from an ongoing project called the IMS Health National Disease and Therapeutic Index to track the frequency of buprenorphine prescribing among U.S. doctors over a 10-year timespan between 2003 and 2013. The National Disease and Therapeutic Index is designed to track outpatient visits at doctors’ offices across America, and includes physicians practicing in a broad range of general and specialized areas of medicine. The researchers specifically looked at the frequency of buprenorphine use as an outpatient treatment for opioid dependence/addiction.
Results from the National Disease and Therapeutic Index indicate that just 160,000 instances of buprenorphine use in a doctor’s office occurred across the U.S. in 2003. By 2013, this number had increased to 2,100,000 instances. The researchers concluded that doctors in essentially all areas of practice increased their rate of buprenorphine prescribing during the timeframe in question. By far, the rate of use increased the most among general physicians, who by definition do not dedicate themselves solely to addiction-related issues. Conversely, even though psychiatrists increased their rate of buprenorphine prescribing, their overall proportion of the total amount of medication prescribed to patients dropped dramatically. (In fact, general physicians now prescribe buprenorphine much more often than psychiatrists.)
The study’s authors note the broad increase in the prescription of buprenorphine as a treatment for opioid dependence/addiction between 2003 and 2013. They also note the significant increase in the use of the medication by general physicians who are not addiction specialists.