Primary care physicians should be able to prescribe opioid addiction treatment with buprenorphine, according to an article published in the New England Journal of Medicine.
Authored by medical doctors Sarah Wakeman and Michael Barnett, the report highlights the importance of normalizing buprenorphine as an office-based addiction treatment. Distribution of the medicine has slowed in annual growth despite an increase in access to buprenorphine. In 2015, 16 percent of 52,000 active psychiatrists were allowed to prescribe it in the U.S., according to the article.
The authors addressed several stigmas and myths surrounding the usage of buprenorphine, which have inhibited its use as a mainstay treatment.
Rather than train new specialists to prescribe the medicine, the authors suggest mobilizing current primary care physicians (PCP) and other generalists such as pediatricians, obstetrician-gynecologists, and HIV physicians to provide treatment with buprenorphine.
Historical precedent has proven this a successful approach, the study argues.
“The importance of mobilizing the PCP workforce while ensuring the availability of sufficient specialists is not unique to the opioid-overdose crisis,” the study says. “During the height of the HIV/AIDS epidemic, for example, access to antiretroviral therapy was urgently needed. Although initially specialists were more likely to prescribe antiretrovirals, by 1990 equal percentages of patients were receiving antiretroviral therapy from PCPs and from specialists.”
The Drug Addiction Treatment Act of 2000 mandates that physicians must complete eight hours of training and apply for a waiver before prescribing buprenorphine; they then can only treat a limited number of patients.
The authors suggest scaling back the regulations and incorporating this training into the education that physicians already must go through. Buprenorphine is a less-complicated medicine to administer than many other routine primary care treatments, according to the study.
Some critics view buprenorphine as a “replacement” drug that patients can become addicted to; the authors disagree. They say addiction is defined by compulsive use of a drug despite harm, which is not applicable to a prescription drug used for managing a chronic illness.
They suggest a public health campaign to reduce the stigma surrounding addiction treatment, again drawing comparison to the HIV/AIDS epidemic.
There is no evidence supporting the effectiveness of detoxification programs for opioid use, but there is strong evidence supporting the success of buprenorphine and methadone treatments, the study states.
“Buprenorphine treatment provides one of the rare opportunities in primary care to see dramatic clinical improvement: it’s hard to imagine a more satisfying clinical experience than helping a patient escape the cycle of active addiction,” the study says.
The study warns against cutting out opioid prescriptions as a means of treatment, since overdose deaths have accelerated since 2011 despite a decrease in prescriptions. In 2016, opioid-overdose deaths increased by 28 percent from the previous year.
This summary was prepared by TCR news intern Marianne Dodson. Readers’ comments welcomed.