Four years ago, in 2019, when Daniel Patrick Garrett was prescribed buprenorphine, a drug used to treat opioid use disorder, he drove to 10 pharmacies before finding one that would fill his prescription.
Garrett said one pharmacy can’t verify your identity without clear identification, another pharmacy wants to get you a deal for painkillers, and a third can’t get you the discount you need to buy the drug. They said they didn’t accept the card. He said. The pharmacy he eventually found to fill his prescription was 160 miles round trip from his home in Jackson, Tennessee. The following year, getting to the clinic became even more difficult when Garrett and his partner separated and he no longer had access to a car.
That’s when Garrett enrolled in his first detox program, which helped pay for his medication. When Garrett first underwent medication-assisted treatment (MAT) in 2019, he was so stressed out during the process of obtaining the medication that he didn’t really see its effects. Things got much better once financial and physical barriers were removed in treatment programs, he said.
“The main issue surrounding MAT access is not the drugs themselves,” Garrett told Salon in a phone interview. “It’s the system by which they are prescribed, dispensed and delivered.”
“The main issue surrounding MAT access is not the drug itself; it is the system in which the drug is prescribed, dispensed, and delivered.”
Substance use disorder patients and their providers must overcome numerous hurdles to access MAT, such as buprenorphine, methadone, and naltrexone. Although all of these drugs are opioids, their functions are significantly different when compared to heroin and morphine. In December 2022, President Biden signed the following agreement: Mainstreaming the MAT Act in 2023This removed one barrier to treatment by eliminating the so-called “X waiver” that doctors had to fill out to allow outpatient use of buprenorphine.
But the bill, passed quietly at the end of the year, has not improved access as much as some people had hoped, with many doctors still hesitant to prescribe these drugs.
“I’m glad it’s gone,” said Dr. Ryan Marino, an emergency medicine physician at Case Western Reserve University School of Medicine, referring to the X waiver. “I’m still skeptical that this will expand accessibility and access.”
Over 46 million people in the US Meets criteria for substance use disorder In 2021, 94% of them received no treatment.Nationwide, it’s over. Half of rural counties do not have a buprenorphine provider. And approximately one-third of Americans who live in rural areas do not have access to buprenorphine. Meanwhile, the number of overdose deaths is at an all-time high. Death toll: More than 111,000 These deaths are primarily caused by opioids such as illicit fentanyl, but are often caused by combinations of drugs such as meth, which are driving the “fourth wave” of the crisis.
F.D.A. approved In 2002, buprenorphine was used to treat opioid use disorder. boxed warning, describes the potential for misuse and abuse and additional requirements for prescribing. Buprenorphine and methadone work to reduce the cravings associated with substance use. Research consistently shows that MAT is effective when: Reduce overdose deaths and relapse — Reduce deaths as much as possible 50% or more -and it is standard treatment For patients with substance use disorders. (Buprenorphine and methadone are also used to treat pain because they partially and fully activate opioid receptors, respectively.)
Buprenorphine is “actually safer than a lot of things that people feel too comfortable prescribing every day.”
As the number of deaths from overdose continues to increase year by year, doctor and Member of Parliament They called on the federal government to remove the extra ring embedded in buprenorphine prescriptions to save lives.Several defended We believe that the removal of the X-waiver is a necessary step in allowing health care providers, especially in rural areas, to prescribe MAT, as well as removing the stigma that the additional restrictions have created for patients. Ta.
“The fact that there was this whole system, this separate licensing requirement and training, meant that prescribers and the general public knew that it was more complex drugs that had some risks, were more difficult to start, and had more risks. It created the false idea that it was,” Marino told Salon in a phone interview. “It’s actually safer than a lot of things that people feel too comfortable prescribing every day.”
Buprenorphine prescribing has increased over the past few decades, and the number of psychiatrists and addiction specialists who can prescribe buprenorphine has increased from about 1,000. 9-12 per 10,000 professionals from 2010 to 2018.Several claim Broadening the base of prescribers to include family doctors and general practitioners is essential, with the number of registered primary care doctors increasing from around 13 to 27 per 10,000 people over the same period. According to one report, between 2006 and 2019, the number of buprenorphine doses supplied nationally increased from 42 million to 577 million. washington post Analysis published last week.
But just because providers have a waiver and the national supply is higher doesn’t mean clinicians are actually prescribing more buprenorphine. One 2020 study It was found that only half of clinicians who received a waiver were writing prescriptions for buprenorphine.in investigation A paper published in July of this year found that the majority of health care providers who had new access to prescribe buprenorphine had previously made no effort to prescribe buprenorphine due to exemptions and educational requirements. He said there was no such thing. However, the same group also reported lack of patient demand as the most common reason for not prescribing the drug since obtaining prescribing rights.
This suggests that further barriers remain. 10 states have their own Regulations regarding the prescription of MAT, a urine test for a health care professional to prescribe buprenorphine, or counseling used in treatment. 2019 investigation We found that only 1 in 5 home health providers are interested in treating opioid use disorder, suggesting that stigma still plays a large role in whether patients receive treatment. ing.
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Regulations still exist regarding the amount of buprenorphine that can be prescribed and the number of patients a doctor with prescribing authority can script.For the treatment of drug use, the recommended dose of buprenorphine is usually 16 milligrams, but recently data This suggests that doses as high as 24 milligrams may be more effective, especially as fentanyl enters the drug supply and drug resistance is increasing due to its high potency. Nevertheless, even if your healthcare provider prescribes buprenorphine; Pharmacies do not always dispense medicines.
For this reason, some doctors have argued that buprenorphine should be allowed to be sold without a prescription, making the drug much more accessible, albeit over-the-counter. “Although the incidence of risks associated with buprenorphine is considered low for individuals and populations, the magnitude of the risks when they do occur is high (overdose death),” they wrote.Pael Jume Roy and Michael Stein I wrote it in JAMA “Ultimately, this risk-benefit calculation favors making buprenorphine available without a prescription and under some regulations.”
Methadone, on the other hand, probably has even stricter regulations. most severely restricted drug is commercially available, and patients should receive the following treatments: Federally Qualified Facility Nationally.
“There’s this weird double standard where you can use methadone to treat pain and there are no restrictions at all,” Marino said. “However, when it comes to treatment for withdrawal and addiction, no one is allowed to prescribe in an outpatient setting and must instead go to a federally qualified opioid treatment facility.”
Some medical schools are working to reduce barriers to prescribing MAT, such as by incorporating buprenorphine training. incorporate into their curriculum. The Mainstreaming MAT Act was passed with additional provisions. requirements The Secretary of Health and Human Services will “conduct a national campaign to educate health care providers about the changes in the law and encourage them to incorporate substance use treatment into their practices.”
Dr. Daniel Ciccarone, a drug use researcher at the University of California, San Francisco who was instrumental in eliminating the said. , but these changes are likely to be slow.
“It’s going to take time,” Ciccarone told Salon in a phone interview. “Just because a policy has changed doesn’t mean there isn’t cultural resistance to it.”
In recent years, many efforts have been made to alleviate the opioid overdose crisis, including policy changes such as the repeal of the X-waiver. lawsuit payment Pharmaceutical companies have filed lawsuits over their role in the overdose crisis and for increased access to naloxone and other harm reduction policies. But these strategies are still being ramped up to meet the vast need, Ciccarone said.
“We’re not there yet,” Ciccarone said. “Meanwhile, people are dying.”
Garrett, who is uninsured in Tennessee, wants to know which primary care providers in his area prescribe MAT so he doesn’t have to shop around for multiple providers like he would at a pharmacy. , said he wished he had more information.
“I was excited to not have to go to the doctor every time I left the hospital for Suboxone. Specifically, it would be cheaper and I would only have to see the doctor once a month, right after I left the hospital. “It will be,” Garrett said. “I thought I would see an ad, see this on the news, hear about this from someone…I haven’t seen any of that.”
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