A look at Medicare data suggests addiction therapy lags far behind the demand.
By Francie Diep
(Photo: Spencer Platt/Getty Images)
For those looking to overcome an addiction to prescription painkillers or heroin, buprenorphine presents a relatively safe and proven option. Yet it’s rarely used: A new study estimates that, among Americans who used Medicare to pay for their prescriptions in 2013, about 80,000 had a script for buprenorphine, commonly known as Suboxone (one of the brand names). Meanwhile, the study’s authors estimate about 300,000 Medicare beneficiaries suffered from an opioid use disorder in 2013.
“Buprenorphine is one of the most effective, proven ways to reduce things like relapse, overdose deaths, crimes, etc.,” says Jonathan Chen, one of the authors, who is a doctor and medical-data researcher at Stanford University. “We have a tool here and, from what we can tell, we’re not using it as much as we could be.”
When someone quits using heroin or prescription painkillers, buprenorphine can reduce cravings and withdrawal symptoms, help to stick to a treatment program, and lower the likelihood of seeking out illicit opioids. Prince appears to have been about to start on buprenorphine when he died in his home in Minneapolis, according to a local news report. Methadone, the better-known addiction-treatment medicine, has similar effects, but it’s not covered by Medicare.
“We have a tool here and, from what we can tell, we’re not using it as much as we could be.”
Many of the 300,000 needy Medicare users Chen and his colleague, Anna Lembke, identified likely weren’t ready to seek treatment. Maybe some of them were getting treated without buprenorphine. Still, the discrepancy points to “significant underutilization,” Chen says. In their paper, published today in the journal JAMA Psychiatry, Chen and Lembke also note Medicare prescribers are far more generous with opioid painkiller prescriptions than they are with opioid addiction treatment scripts. For every 40 family doctors in their data who wrote scripts for Schedule II painkillers, only one wrote a prescription for buprenorphine.
Why is buprenorphine so unpopular? For one thing, there’s a stigma attached to it. Because it’s also an opioid, some believe giving it to those with opioid use disorders is just replacing one addiction with another. The science suggests that’s not true, however, and groups including the World Health Organization and the White House Office of National Drug Control Policy endorse buprenorphine therapy.
Another potential reason for its unpopularity: Prescribing buprenorphine means extra work for doctors. To do so legally, doctors must undergo eight or nine hours of extra training, Chen says. Then they have be willing to take on patients with opioid use disorders.
The Opioid Addiction and Recovery Act of 2016, which recently passed the Senate, offers grants to states, tribes, and other jurisdictions to make treatment programs that prescribe medicines like buprenorphine and methadone more available. It remains to be seen exactly how they’ll do that.