NYT: Buprenorphine underused despite proven benefits

Despite the proven effectiveness of buprenorphine to treat opioid use disorder (OUD), it remains drastically under-prescribed.

The stats:

• A 2022 study found that only about half of the nation’s top-ranked hospitals said they provided buprenorphine in their emergency department.
• Hundreds of counties still lack any medication for opioid use disorder (MOUD) providers.
• And where those providers do exist, they often will not accept Medicare or Medicaid patients.

The reasons: Experts cite various reasons buprenorphine has not been adopted more quickly:

• History of onerous regulations. For years, there was a special waiver that prescribers needed in order to prescribe buprenorphine, which required special training and limited the number of patients doctors could treat with buprenorphine. The waiver requirement was eliminated in 2023, but the number of buprenorphine prescriptions has not meaningfully increased. This may be in part because the Drug Enforcement Administration (DEA) still monitors buprenorphine (an opioid) through its Suspicious Orders Report System (SORS), and doctors may fear being investigated if SORS detects a spike in prescriptions.
• Doctors’ lack of familiarity. Many doctors remain unfamiliar with buprenorphine because they never learned how to use it. Medical school and other training requirements often have little focus on addiction and buprenorphine.
• Stigma. Many doctors do not view treating addiction as part of their job (due to lack of training), and even health care providers often hold stigmatizing views about people with addiction and medications for addiction treatment.
• Limited funding. Well-funded, top-down programs that provide incentives for hospitals and other health care organizations to offer the treatment may be needed for buprenorphine to become widely and quickly adopted. Such an approach could also help by giving “institutional cover” to doctors who would otherwise be hesitant to prescribe buprenorphine. Mandates or directives, though, can spark backlash.

BUT: Some doctors are trying to change this, including by opening bridge clinics that provide buprenorphine in the emergency department.

• They aim to demonstrate that good treatment for OUD exists, and doctors can deploy it easily in their emergency departments.

What’s coming: The Trump administration’s position on MOUD is unclear.

• Trump’s support for a more punitive approach to the addiction crisis and his desire to slash government spending (i.e., cuts to Medicaid, the Affordable Care Act, other federal health programs) worry proponents of MOUD.
• But: It is also possible that Trump will expand the public health approach he embraced during his first term and continue efforts to roll out MOUD.

Source: An Effective Treatment for Opioid Addiction Exists. Why Isn’t It Used More? (New York Times)