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This Drug Could Help End the Opioid Crisis

This Drug Could Help End the Opioid Crisis

(Bloomberg Opinion) -- America’s battle against opioid addiction needs to be fought on both the supply and demand fronts, everyone agrees. It’s important to get doctors to stop prescribing too many opioids, to crack down on importation of heroin and fentanyl, and to hold pharmaceutical companies to account for irresponsible marketing practices. But it is at least as essential to make sure that doctors are able to use every tool at their disposal to help the more than 2 million people already addicted to the drugs to recover.

Because overuse of opioids causes changes in brain structure and function, the best way to help sufferers is with medications — notably buprenorphine, a particularly effective medicine for opioid-use disorder. Most sufferers lack access to this treatment. Many more doctors, nurse practitioners and physician assistants should be trained to provide it.

Buprenorphine could be transformative in the treatment of addiction. It reduces craving because it’s an opioid, but it acts differently than hydrocodone, heroin and the rest. Thanks to its “ceiling effect,” it poses a low risk of overdose. And when used to treat people who are addicted to other opioids, buprenorphine causes no euphoria.

While other medications are available, buprenorphine offers particular promise. Methadone is effective, but it can be dispensed only in special clinics. A third drug treatment for opioid dependence, naltrexone, which blocks the effects of narcotics, can be given only to people who have been through at least seven days of opioid withdrawal. Not all patients manage to do that.

The catch with buprenorphine is that it can be prescribed only by the small fraction of doctors, nurse practitioners and physician assistants who’ve obtained a special waiver.

Oddly enough, this restriction is a product of an earlier initiative to broaden opioid treatment. Two decades ago, when doctors wanted to expand treatment beyond methadone clinics, the Drug Addiction Treatment Act of 2000 enabled them to get a waiver to prescribe buprenorphine in their own offices. Congress later increased the number of patients whom doctors could treat, and extended the waivers to nurse practitioners and physician assistants. But too few clinicians have gotten the extra training, and today most rural counties have no doctors with the necessary authorization.

The result borders on the absurd. It’s easy for doctors to prescribe opioids for pain. But they need a waiver to prescribe buprenorphine to treat addiction. 

It is essential that clinicians be schooled in addiction treatment. It should be part of regular medical training. All doctors who prescribe buprenorphine should be taught the benefits of counseling where available (in many rural areas, it isn’t) and the need to closely follow patients’ progress.

Ultimately, medication-based treatment for opioid dependency should be a normal element of primary care. Making it so would provide effective treatment to many more patients, lessen the stigma of addiction, and dispel the harmful myth that methadone and buprenorphine only allow patients to get high. With medical schools and residency programs providing sufficient training, Congress could lift the waiver requirement — and real progress on the addiction crisis would then be possible.

Editorials are written by the Bloomberg Opinion editorial board.

©2019 Bloomberg L.P.