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Why is an Effective Opioid Addiction Medication being Restricted?

Buprenorphine, found in the popular drug Suboxone, has been proven to be effective for opioid addiction treatment. So why is it increasingly harder to get? Doctors and pharmacists alike run into problems when prescribing the drug for opioid addiction treatment. Restriction on both doctors and pharmacies keep the drug hard to obtain and keep its potential for illegal street use increasing.

What is Buprenorphine?

Buprenorphine is a partial opioid agonist. It is part of the only 3 FDA approved opioid addiction treatment medications. Essentially it’s a low-dose opioid that is meant to curb opioid withdrawal symptoms. The popular opioid treatment drug Suboxone contains buprenorphine. Suboxone is a combination of buprenorphine and naloxone, an opioid antagonist. While buprenorphine delivers a low opioid dose, naloxone works to block opioid receptors. Therefore, the drug is meant to keep withdrawal symptoms at bay and help a patient come off opioids slowly. Many medical professionals approve of buprenorphine treatment paired with a behavioral therapy program.    

Problems for Doctors

According to federal law, in order to prescribe buprenorphine doctors must apply for a waiver from the federal Substance Abuse and Mental Health Services Administration. They must obtain 8 hours of training before they can prescribe it and they can only prescribe to 30 patients at a time after getting the waiver. Given these tough constraints, most doctors don’t bother to obtain the waiver.  

Training for prescribing buprenorphine is also inconsistent. Doctors and medical professionals are instructed to prescribe it as a long-term treatment, according to SAMHSA guidelines. Pharmacists, however, might view long-term prescriptions as increasing the risk of long-term dependency. When taken in pill or tablet form, buprenorphine is unlikely to cause the same euphoric effects as heroin, but it might if dissolved or injected. Many use it to avoid withdrawal in between shooting heroin or fentanyl. 

Problems for Pharmacies

Problem also arises that even if doctors prescribe the drug, it’s hard to find a pharmacy that stocks it. Not only stock it, but keep it available for refill and have an open conversation with the pharmacist throughout the process. The reasons pharmacists are hesitant are also to do with how the drug is being used after it is prescribed. Some smaller, independent pharmacies started stocking buprenorphine, but they found that many patients weren’t using the drug, they were selling it.  

Pharmacies trying to stock buprenorphine run into problems with wholesalers. Distributors of the drug require it to be ordered in small, consistent batches. This is seemingly to avoid the amount of potentially addictive prescriptions under one roof at one time. Pharmacies can apply for a waiver to stock more, but increasing the amount of controlled substances draws further scrutiny from wholesalers and the federal Drug Enforcement Agency.  

Next Steps

Pharmacists and doctors understand the benefits of buprenorphine in treating opioid addiction. Both know that going through opioid withdrawal without the drug can be potentially life-threatening. But many pharmacists don’t want to assume the risk of carrying it because of its potential for addiction and street use. Doctors are also under such scrutiny in prescribing the drug, they often avoid it. Sadly, addicts looking to get off opioids can also usually find buprenorphine faster and cheaper on the street. 

If you or a loved one are struggling with addiction, help is available. Behavioral therapy along with medication-assisted addiction treatment can be very beneficial in treating addiction. Rock Recovery Center in West Palm Beach, Florida can help with advice on next steps. Call our 24-hour helpline or chat live with us now.

Additional Resources

SAMHSA: Medication-Assisted Treatment