Overdose deaths didn’t rise after prescription rules relaxed, study says

Treatment improves outcomes, reduces risk of death from an opioid overdose, local expert says

The proportion of drug overdose deaths involving buprenorphine, a drug used to treat opioid use disorders, did not increase after relaxed access to the treatment drug during the COVID-19 pandemic, a new study says.

The study, published recently in the Journal of the American Medical Association, said that of approximately 74,474 opioid-involved overdose deaths, buprenorphine was involved in 2.6% of the deaths during July 2019 to June 2021. Although monthly opioid-involved overdose deaths increased, the proportion involving buprenorphine fluctuated but did not increase.

“Buprenorphine was approved by the FDA for treatment of opioid use disorder in 2002, and it has been shown to improve outcomes and even reduce the risk of death from an opioid overdose,” said Dr. Natalie Lester, chief medical officer of OneFifteen.

Buprenorphine, marketed under the brand names Suboxone or Subutex, is an FDA-approved treatment for opioid use disorder that is usually taken as either a tablet or a film absorbed under the tongue, Lester said.

“It works by stimulating opioid receptors in the brain so that a person does not go into withdrawal, and it reduces cravings for opioids,” Lester said. When someone takes buprenorphine, it does not cause the same sense of euphoria or “high” that other opioids, like heroin or fentanyl, can cause.

“When someone becomes dependent on fentanyl or other opioids, the cycle of repeated drug use continues in part to prevent opioid withdrawal, which is experienced as a severe flu-like condition with full body aches, muscle cramping, restlessness, and diarrhea, among other symptoms,” Lester said.

Buprenorphine alleviates the withdrawal symptoms, and those one opioid use disorders can transition to taking buprenorphine as a maintenance medication taken once or twice a day, she said.

“It can be taken like this for months or years in the treatment of opioid use disorder. The person feels back to their normal selves and can focus on aspects of their life other than their addiction,” Lester said.

U.S. law required doctors to prescribe buprenorphine in office-based settings, and doctors also had to have a Drug Addiction Treatment Act waiver. Doctors were also limited on the number of prescriptions they could give, such as 30, 100, or 275 patients at time, depending on the waiver.

During the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration and the Drug Enforcement Administration allowed Drug Addiction Treatment Act–waivered clinicians to remotely prescribe buprenorphine to new patients without conducting in-person examinations, the JAMA study says. The Centers for Medicare and Medicaid Services expanded payment for telehealth services and provided flexibility on accepted communication technologies, like audio only, for clinical care of substance use disorders.

“Use of telehealth is one way to overcome barriers to treatment, such as geographical limitations, lack of transportation, and stigma. Greater numbers of individuals struggling with opioid addiction have been able to access this life-saving medication,” Lester said.

Researchers in the study say their findings could inform ongoing policy discussions, such as conversations on potentially adopting the COVID-19 emergency authorizations related to buprenorphine permanently. Researchers also say that while the overdose deaths involving buprenorphine were rare, it still highlights a need for overdose prevention and support for those taking buprenorphine.

Accidental drug overdose deaths in Montgomery County decreased by 8.9% in 2022 compared to the previous year, according to preliminary data from the Montgomery County Coroner’s Office. There were approximately 307 accidental drug overdose deaths in 2022, according to Montgomery County Coroner’s Office. This is down by almost 9% from 2021, when there were 337 confirmed overdose deaths.

Preliminary data also shows there have been 23 accidental drug overdose deaths in 2023, which was the same as it was for January 2022.

Fighting the opioid crisis continues to remain costly, as well, as new data from Premier Inc. AI Applied Sciences, a group purchasing organization, says the annual cost of outpatient visits and inpatient admissions for opioid use disorders is estimated to be $95.4 billion nationally, or 7.86% of all hospital expenditures. The company estimates that approximately $67 billion of those expenses are paid for by Medicare and Medicaid programs.

In regard to medication-assisted treatment, Lester said individuals should just think of it as treatment.

“We used to think that abstinence, willpower, and psychotherapy were the only ways to address addiction, but now we know that medications, like buprenorphine, are a key part of treatment for many individuals,” Lester said.

She said medical professionals have been moving away from using terms like “medication-assisted,” saying, “Medication is treatment. Buprenorphine is lifesaving.”

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