To fight the opioid crisis, the US needs to look at what works

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Washington Examiner on 8/16/2018 by Erin Dunne

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The Center for Disease Control and Prevention released preliminary overdose estimates for 2017. Although a few states offer some encouraging examples of progress, the estimates — or even just one, the record 72,000 overdose deaths — offer a troubling look at how the United States is still struggling to address addiction. Of those deaths, the majority, over 49,000, were from opioid overdose.

To help curb opioid overdoses and provide treatment, we need to look at what works.

One of methods that does work, and is backed up with evidence from several studies, is access to medication-assisted treatment programs — specifically buprenorphine (commonly known as Subutex, Suboxone, or a number of other brands). These are programs where a doctor prescribes one of these medications to reduce the cravings of someone suffering from opioid use disorder and, hopefully, enter long-term recovery.

Key to understanding how buprenorphine helps is an understanding of the difference between physical dependence and addiction. This can be a confusing distinction, as the terms are sometimes used interchangeably. Addiction is essentially an uncontrollable craving and an inability to control use. These symptoms, specifically cravings, the hallmark of addiction, can lead to self-destructive behavior and can be fatal.

Dependence, on the other hand, is the term used to describe the physical reliance on opioids. Normally, humans produce opioids naturally, but continued use of opioids builds tolerance and the body comes to depend on the external source of opioids just to be “normal” or at equilibrium.

Buprenorphine is an opioid, but a weak enough one that won’t get someone used to using stronger drugs high. Its use in treatment can help change addiction into a managed, predictable, and treatable dependency. That means that the body’s need for opioids is managed, and the person who was suffering from addiction no longer feels the same sort of cravings.

Moreover, in treatment, buprenorphine is combined with naloxone, which helps prevent the misuse or abuse of medication prescribed to treat addiction. Naloxone is an opioid antagonist which, when administered during overdose, competes or blocks the effects of other opioids. When administered as a medication orally, naloxone doesn’t have the forceful impact that it does when injected during an overdose, but its inclusion in a patient’s regimen helps to lower the risk of addiction as it still functions as an antagonist.

In theory, the buprenorphine/naloxone combination should be readily available and could act as a key defense against the clearly on going opioid problem in the U.S. Unlike methadone, another option for medication-assisted treatment of opioid addiction, buprenorphine can be prescribed in an office setting.

Unfortunately, buprenorphine remains out of reach for many Americans who could benefit from treatment. A recent study, for example, found that even among those who had overdosed, only 30 percent had access to medication-assisted treatment within a year.

One reason is a simple lack of access to physicians who can prescribe the treatment. Currently, per DEA regulations, no doctor can have more than 100 buprenorphine patients at a time, meaning that people who want treatment and doctors who can provide it are cut off by words and rules from the government. Additionally, emergency rooms, which often treat victims of overdose, have difficulty starting treatment there again, because of regulatory hoops.

Another block to those seeking treatment is insurance companies that have prior-authorization requirements for access to buprenorphine. These requirements lead to delays in access and add an extra barrier for those seeking treatment.

The CDC numbers are devastating. What is worse, though, is knowing that there are treatments that work and that the people who need them don’t have access to them. That should be unacceptable to lawmakers and the public.