Feds seek ways to expand use of addiction drug (Update)

June 18, 2014 by Matthew Perrone

The government's top drug abuse experts are struggling to find ways to expand use of a medicine that is considered the best therapy for treating heroin and painkiller addiction.

Sen. Carl Levin of Michigan on Wednesday pressed officials from the White House, the National Institute of Drug Abuse and other agencies to increase access to buprenorphine, a medication which helps control drug cravings and withdrawal symptoms. It remains underused a decade after its launch.

First approved in 2002—under a law crafted by Levin, a Democrat, and Utah Republican Sen. Orrin Hatch—buprenorphine was hailed as a major advance over methadone, the decades-old standard for addiction treatment. Among other advantages, buprenorphine has a lower risk of overdose and milder side effects. It can be prescribed as a take-home medication in the privacy of a doctor's office, helping patients avoid the stigma of going to a methadone clinic.

But even amid a national epidemic of drug abuse and addiction, access to buprenorphine remains limited by federal restrictions, inconsistent insurance coverage and a lack of acceptance by physicians.

"As long as we have too few doctors certified to prescribe bupe, we will be missing a major weapon in the fight against the ravages of addiction," Levin told the forum, which also included patients and non-government medical experts.

Only 4 percent of the 625,000 U.S doctors who are eligible to prescribe buprenorphine have received certification to use the drug, which comes as a pill or a film that dissolves under the tongue. Certification requires an eight hour training course in addiction medicine.

Meanwhile an estimated 2.5 million Americans are addicted to prescription painkillers or heroin, known collectively as opioids, and less than half are receiving medical treatment.

"It's somewhat paradoxical that physicians will use opioids to create a problem, but there seems to be reluctance to help address the problem," said Dr. Westley Clark of the Center for Substance Abuse Treatment. Clark and other experts noted that there is still a stigma attached to treating opioid addiction and many physicians are uninterested in learning how to use drugs like buprenorphine.

Government officials agreed that more training is needed to familiarize both medical students and experienced physicians with science showing that addiction can be successfully treated with medication.

Even among doctors who are certified to prescribe buprenorphine, federal law caps the number of patients they can treat at 100.

Dr. Corey Waller, an addiction specialist from Grand Rapids, Michigan, said he has a constant waiting list of patients trying to get a prescription.

"It's the only medication that has a limit of treatment capability out of all the medicines in the U.S.," said Waller, who also spoke on behalf of the American Society of Addiction Medicine. The group has proposed raising the cap to as high as 500 patients for physicians who complete 40 hours of training.

But federal officials cautioned against raising the number, noting that buprenorphine itself can be abused.

Dr. Nora Volkow, director of the National Institute on Drug Abuse, noted that buprenorphine overdoses are routinely reported in Europe, where the drug is less restricted. Other officials warned that raising the prescribing limit might lead to buprenorphine pill mills, where rogue doctors prescribe drugs indiscriminately in exchange for money from addicts.

Methadone and buprenorphine are themselves opioids, part of that class of highly addictive drugs that mimic the effect of the opium poppy. When dosed carefully though, both drugs can reduce opioid withdrawal symptoms— including anxiety, sweating, nausea and vomiting—without producing the euphoric high seen with drugs like heroin.

Despite similarities between methadone and buprenorphine, doctors and recovering addicts agree buprenorphine has clear benefits. Patients report less fatigue and mental fogginess on the newer drug. Most significantly, buprenorphine can be prescribed in an extended take-home supply, freeing patients from making daily trips to methadone clinics.

"It's a drug that allows us to lead a normal life," said Dr. John Kitzmiller, a Michigan doctor who recovered from his own opioid addiction using buprenorphine. "You can't live a normal life on methadone."

Explore further: Heroin addicts have higher pain sensitivity, even during treatment

Related Stories

Heroin addicts have higher pain sensitivity, even during treatment

April 25, 2012
(HealthDay) -- Heroin addicts often have an increased sensitivity to pain, and this sensitivity does not subside over the course of treatment with methadone or other opioids, new research finds.

Longer detox might work better for prescription pain med addiction

October 23, 2013
(HealthDay)—A longer period of detoxification may be more effective for people being treated for addiction to prescription painkillers called opioids, according to a small new study.

Cognitive behavioral therapy adds no value to drug treatment for opioid dependence

January 4, 2013
(Medical Xpress)—In a surprise finding, Yale researchers report that adding cognitive behavioral therapy to the most commonly used drug treatment for opioid dependence does not further reduce illicit drug use by patients. ...

Study addresses treatments for waited-listed opioid-dependent individuals

April 10, 2014
addiction to heroin and prescription painkillers – has reached epidemic levels across the country, with treatment waitlists also at an all-time high. However, ensuring timely access to effective treatment – particularly ...

Suboxone is most effective in treating painkiller addiction

November 7, 2011
Individuals addicted to prescription painkillers are more likely to succeed in treatment with the aid of the medication buprenorphine-naloxone (Suboxone), report McLean Hospital and Harvard Medical School researchers in today's ...

HHS leaders call for expanded use of medications to combat opioid overdose epidemic

April 24, 2014
A national response to the epidemic of prescription opioid overdose deaths was outlined yesterday in the New England Journal of Medicine by leaders of agencies in the U.S. Department of Health and Human Services. The commentary ...

Recommended for you

Study suggests ending opioid epidemic will take years

July 20, 2017
The question of how to stem the nation's opioid epidemic now has a major detailed response. A new study chaired by University of Virginia School of Law Professor Richard Bonnie provides extensive recommendations for curbing ...

Team-based model reduces prescription opioid use among patients with chronic pain by 40 percent

July 17, 2017
A new, team-based, primary care model is decreasing prescription opioid use among patients with chronic pain by 40 percent, according to a new study out of Boston Medical Center's Grayken Center for Addiction Medicine, which ...

Private clinics' peddling of unproven stem cell treatments is unsafe and unethical

July 7, 2017
Stem cell science is an area of medical research that continues to offer great promise. But as this week's paper in Science Translational Medicine highlights, a growing number of clinics around the globe, including in Australia, ...

Popular heartburn drugs linked to higher death risk

July 4, 2017
Popular heartburn drugs called proton pump inhibitors (PPIs) have been linked to a variety of health problems, including serious kidney damage, bone fractures and dementia. Now, a new study from Washington University School ...

Most reproductive-age women using opioids also use another substance

June 30, 2017
The majority of reproductive-age and pregnant women who use opioids for non-medical purposes also use at least one other substance, ranging from nicotine or alcohol to cocaine, according to a University of Pittsburgh Graduate ...

At-risk chronic pain patients taper opioids successfully with psychological tools

June 28, 2017
Psychological support and new coping skills are helping patients at high risk of developing chronic pain and long-term, high-dose opioid use taper their opioids and rebuild their lives with activities that are meaningful ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.