Easing prescription rules for opioid treatment did not increase overdose deaths, study finds

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A new study shows that easing restrictions on buprenorphine, a drug that can treat opioid use disorder, did not lead to an increase in treatment-related overdose deaths. The findings may help address concerns that making buprenorphine more widely available 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 abuse and overdose, making it the most accessible of all the options, but it remains the “least used,” according to the study.

There are restrictions on who can prescribe buprenorphine and where it can be obtained. It is classified as a Schedule III controlled substance, meaning it has a moderate or low risk of addiction. Previously, buprenorphine had to be prescribed by a doctor registered with the Drug Enforcement Administration. Recent policy changes removed the requirement, commonly known as “opt-out X,” which limited the number of patients a provider could prescribe buprenorphine.

Changes to federal regulations during the coronavirus pandemic have allowed qualified clinics appoints remotely buprenorphine waives the requirement for individual assessment, even for new patients. This change will remain in place until the federal government lifts the public health emergency declared in April 2020.

To determine the impact of these policy changes, federal researchers looked at 89,111 overdose deaths reported in 32 jurisdictions from July 2019, before the changes took effect, to June 2021, about 15 months after the new policy was implemented. Of the 89,111 overdose deaths, 74,474 were related to opioids.

Only 1,995 cases of opioid-related deaths involved buprenorphine. Overall, buprenorphine was found in 2.2% of all drug overdose deaths and 2.6% of opioid overdose deaths.

despite growing up overdose death Buprenorphine overdose deaths did not increase from 2019 to 2021. Between July 2019 and June 2021, there were some fluctuations, but the death rate decreased or remained stable, the researchers found.

“Our findings suggest that expanded prescriptions are not associated with a disproportionate number of buprenorphine-related deaths,” researchers said in the study, a joint effort of the National Institute on Drug Abuse and the Centers for Disease Control and Prevention.

“However, although rare, buprenorphine-related overdose deaths highlight the importance of overdose prevention and support for individuals using buprenorphine under medical supervision or outside of SUD treatment. [substance use disorder] or pain,” they wrote.

The researchers also said more equitable access to drugs and other “harm reduction strategies” is needed to help solve the overdose crisis.

Another finding of the study was that less than a quarter of buprenorphine-related overdose deaths involved people receiving opioid use disorder treatment at the time of death, and even fewer—about 20%—were receiving specific medication to manage the problem.

Only 3.2% of opioid overdose deaths received treatment.

According to the researchers, this “remarkable finding” “highlights the need to expand access to evidence-based treatments, particularly medications for OUD; improve treatment adherence; and supporting long-term recovery”.

A large part of the reason buprenorphine is restricted is because of the fear that it may be “diverted,” or that the person receiving the prescription may give it to someone else. The study looked at this issue and found that some abuse may occur, possibly because people are trying to “de-addiction and self-medicate” due to a lack of formal access to treatment. This study, along with previous studies, concluded that people are unlikely to abuse buprenorphine to get a “high.”

The researchers said their findings are consistent with a 2022 study that reported no association between COVID-era flexibility for methadone treatment and methadone-related overdose deaths. In most cases, methadone patients must visit clinics every day to receive their doses, but during the pandemic, patients were allowed to take the medication for up to a month at a time.

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