Today’s illicit drug supply is riskier than ever, experts say. It’s often contaminated by different dangerous substances—from the potent opioid fentanyl, to the horse tranquilizer xylazine, to benzodiazepines—which makes using illegal drugs more unpredictable and raises the risk of overdose.
Effective treatments are essential because of these risks. However, one of the most successful treatments for opioid dependence—buprenorphine—is difficult to get at most pharmacies across the country, according to a new study published in the journal Alcohol and Drug Dependence.
Researchers conducted secret-shopper phone calls to nearly 5,000 pharmacies in 11 states from 2020 to 2021 and found that buprenorphine, an opioid-dependence drug that has been shown to halve opioid users’ risk of dying, was readily available in less than half of them. Certain states were more accessible than others. California’s buprenorphine availability was lowest at 31%, with Maine having the highest supply of 86%. It was also discovered that only 70% of pharmacies had Narcan nasal spray, which can reverse the side effects of overdosing, while naloxone (which is used to treat such cases) was available.
The results suggest that many health-care professionals don’t regard opioid-dependence drugs—especially buprenorphine—as life-saving, essential treatments, says study co-author Lucas Hill, director of the pharmacy addictions research and medicine program at the University of Texas at Austin’s College of Pharmacy. “It’s frustrating to see health professionals of all types continue to see buprenorphine as an optional part of their health care practice,” he said. “Buprenorphine is our best tool to help people with opioid use disorder who are at risk of overdose death, due to the current poisoning of the illegal drug supply.”
Buprenorphine can be dispensed under the name Suboxone. This combination of buprenorphine/naloxone is essential for patients suffering from opioid addiction. It is also preferred by many over the other two medications, methadone/naltrexone. Buprenorphine, unlike methadone can legally be prescribed without the need for an opioid treatment program. And compared to patients using naltrexone—which blocks the effects of opioids—it’s easier to initiate, because patients don’t need to detox before starting treatment. This allows patients to preserve their opioid tolerance which reduces the risk of overdosing on an opioid later.
Despite the drug’s efficacy, it’s been tightly regulated since it was first approved for opioid use disorder 20 years ago—in part, because buprenorphine itself is an opioid and has potential for abuse. Recently, the U.S. Drug Enforcement Administration has taken steps to crack down on buprenorphine-selling pharmacies. This controlled drug is a restricted substance. Special licenses are required by doctors, pharmacists and others who prescribe buprenorphine. Advocates claim that X waivers are not available for more than 10% of physicians. This means patients will be able to access treatment at a lower rate.
Hill’s research revealed three trends that predict whether a pharmacy is likely to carry buprenorphine. National chains and large pharmacies are more likely than independent pharmacies to carry it. It’s also more likely to be available in pharmacies in states that have expanded Medicaid, as well as in states where opioid overdose deaths are more common. Although California has expanded Medicaid, it still provides less access to buprenorphine compared with most states.
Some independent pharmacists have reported being reluctant to carry buprenorphine because they’re concerned that filling too many prescriptions of the drug may trigger a DEA investigation. Wholesalers of buprenorphine are obliged to report suspicious orders to the DEA. Taleed El-Sabawi, an assistant professor of law at Florida International University College of Law who studies addiction, argues that the DEA should issue official guidelines about dispensing buprenorphine to make it clear to pharmacists that they can offer it to patients without repercussions and direct a campaign to promote dispensing buprenorphine directly to pharmacies that aren’t carrying it. “The DEA is feared by the pharmacists,” says El-Sabawi.
Hill states that some pharmacists worry about the lack of demand. The drugs could end up on shelves and become obsolete. Hill also said that there is another deterrent: the persistent stigma surrounding people with opioid addiction disorder.
Hill believes that in this time of crisis, pharmacists need to forget about their fears and provide buprenorphine for those who are suffering from overdoses. “If you’re not sure, the answer is always to lean toward dispensing,” he says, “because this is a life-saving medication.”
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