According to a new study, significant challenges remain before the majority of American clinicians feel secure treating patients with buprenorphine.
Recent federal efforts to deregulate buprenorphine have resulted in an increase in the number of prescribers but not in an increase in overall prescribing volume.
According to the study, many healthcare providers continue to view prescribing buprenorphine as problematic or have little interest in using the medication.
The research, published in JAMA Health Forum on Friday, highlights two significant obstacles: allowing U.S. healthcare providers to provide addiction medications and then convincing them to use the medications to treat patients.
Chris Jones, the study’s lead author and a longtime federal addiction policy official who currently serves as director of the Centers for Disease Control and Prevention’s injury prevention division, stated, The number of people receiving the modified waiver increased, but the number of people receiving buprenorphine prescriptions did not change.
This survey allowed us to investigate: So, you’ve taken the initiative to obtain the modified waiver. What other obstacles are you encountering that prevent you from prescribing?”
The new research follows several government actions that have made it substantially easier to provide buprenorphine, the only medication available outside of specialized clinics that reduces cravings and withdrawal symptoms to treat opioid addiction.
In order to prescribe buprenorphine after late 2020, prescribers were required to obtain a so-called “X-waiver” or “DATA-waiver,” a special license requiring special training.
Doctors were required to complete eight hours of additional training, while nurse practitioners and physician assistants were required to complete 24 hours.
During its final days in office, the Trump administration effectively eliminated the requirement, allowing providers to treat up to 30 patients with buprenorphine without additional training. Upon taking office, the Biden administration placed the regulation on hold, but in April 2021, it implemented a nearly identical policy.
Recently, Congress eliminated the training requirement entirely, allowing healthcare professionals to treat buprenorphine as they would any other medication. However, Drug Enforcement Administration-certified prescribers must continue their education to maintain their license.
However, the loosened restrictions have not completely resolved the issue. Recent research indicates that despite an increase in the number of buprenorphine providers, aggregate prescribing volumes have not increased significantly.
The new study provides an explanation. Clinicians reported a laundry list of other barriers that prevented them from prescribing buprenorphine, including concerns about DEA overreach, insurance approval processes, a lack of institutional support, misuse of buprenorphine, and the treatment of patients with opioid use disorder.
In addition, a significant number of physician assistant and nurse practitioner prescribers reported they were unable to locate a supervising physician to oversee their practice, as is still required by several states.
The paper’s authors, who include top officials from the Substance Abuse and Mental Health Services Administration and other government agencies, wrote, “The findings suggest that, as the implementation of legislation removing the DATA waiver commences, addressing these barriers could be crucial to increasing buprenorphine access.”
Experts in public health and the Biden administration have long identified expanding access to addiction medications as a critical component of the nation’s response to the opioid crisis.
Currently, only methadone and buprenorphine are approved to treat opioid addiction. However, methadone is only available in specialized clinics, leaving buprenorphine as the only anti-addiction instrument for many American providers.
Despite the federal government’s elimination of restrictions on buprenorphine, the substance has become more difficult to administer. The prevalence of fentanyl, in particular, has left clinicians scrambling to help patients avoid precipitated withdrawal—essentially, withdrawal symptoms caused by buprenorphine’s relative frailty in comparison to fentanyl’s enormous potency.
Jones emphasized that buprenorphine remains an essential treatment for opioid use disorder. While the elimination of the X-waiver did not immediately result in a significant increase in the number of prescribers or overall prescribing volumes, he added that such an increase is possible if the medical community and the nation as a whole can continue to change the culture surrounding addiction treatment.
“We must also educate and engage providers on how to manage patients with opioid use disorder so that they feel more at ease,” Jones said, “and raise awareness about the very real, lifesaving benefits of buprenorphine and medications for opioid addiction, not only among clinicians but among patients as well.”
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