New Study Examines Barriers to Buprenorphine Treatment

A New Study on Access to Buprenorphine

On August 21, a team of researchers from the University of Massachusetts Amherst published a study which examines why many people who have addictions to opioids never receive treatment with buprenorphine. The FDA approved buprenorphine as a medication for opioid dependence in 2002. Since then, addiction recovery experts have recommended that buprenorphine play a role in medication-assisted treatment, especially for patients who cannot access treatment with methadone. However, the study indicates that many patients who could benefit from buprenorphine cannot obtain it or choose not to use it.

What Is Buprenorphine?

Buprenorphine is an opioid, but its effects are unique. As a partial opioid agonist, buprenorphine binds to opioid receptors in the brain, yet it does not cause the same degree of sedation and euphoria as other opioids. Buprenorphine is useful because it suppresses opioid withdrawal and prevents other opioids from affecting the brain. Therefore, someone with an opioid addiction can use buprenorphine to detox from opioids without unbearable withdrawal symptoms. Buprenorphine is an ingredient in several anti-addiction medications, including Suboxone. With professional medical supervision, opioid-dependent patients can use buprenorphine to break free from an opioid use disorder and eliminate opioid cravings. Once patients successfully overcome dependence, they stop taking buprenorphine and progress to therapy at a rehab center to maintain their recovery.

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Since it has the potential to cause tolerance and overdose when misused, buprenorphine is a Schedule III controlled substance under American law. Therefore, there are restrictions on who may provide it. More specifically, only licensed doctors may prescribe buprenorphine, and only treatment programs certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) may offer it as part of a recovery plan.

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What Did the Study Find?

According to lead researcher Elizabeth Evans, “very few people with opioid use disorder ever get treatment for it – 10 percent or less,” and even fewer use buprenorphine for opioid addiction treatment. To determine the reasons why buprenorphine is absent from so many treatment plans, Evans and her team examined survey data from over one thousand adults in five states who participated in a clinical trial for buprenorphine. The researchers found that only 9.3% to 11.2% of the participants used buprenorphine to treat opioid addiction during the two years after the clinical trial.

When the researchers asked the participants why they did not use buprenorphine, 51.9% responded by saying that buprenorphine is too expensive or difficult to obtain. However, as Evans notes, “increasing access is important, but we need to address why people find that medication [buprenorphine] to be unacceptable.” The study reveals that some participants refused to use buprenorphine, even though it was available to them, because they did not consider it to be an acceptable or worthwhile option.

Among this group of respondents, 72.9% said that they didn’t want to use buprenorphine because their bodies react to it negatively, 47.1% said they wanted to avoid side-effects, 38.6% complained about having to go to a clinic everyday to get a supply of the medication, 41.4% of the respondents stopped taking it because it completely prevented them from using other opioids, and 30% claimed that buprenorphine is not effective. Respondents were able to give more than one answer.

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What Does the Study Recommend?

The study concludes that health care providers should make greater efforts to educate patients about the benefits of buprenorphine and dispel misconceptions about buprenorphine treatment. According to the researchers, patients who have access to buprenorphine and believe that it’s safe and helpful are most likely to use it consistently and properly. Moreover, patients who harbor negative beliefs about buprenorphine self-impose a barrier to access to a potential source of treatment.

We need to flip the narrative. We know this [opioid addiction] is a chronic health condition. The good news is that buprenorphine is effective, but only if patients take it. We need to help patients access and use medication that will help them avoid a return to opioid use.

- Elizabeth Evans, University of Massachusetts Amherst

The study also recommends increasing access to the medication for groups which least commonly use buprenorphine for treatment: Americans in West Coast states, Hispanics, and people who have already started treating opioid addiction with methadone.

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