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Deregulating Buprenorphine Could Save Thousands Of Lives, Physicians Say

An opinion piece by two physicians published in STAT Tuesday argues that deregulation of the opioid addiction treatment drug, buprenorphine, could save tens of thousands of lives every year.The authors, University of Rochester Professor Kevin Fiscella and Sarah E. Wakeman, director of the Massachusetts General Hospital Substance Use Disorders Initiative, strongly believe that making it as easy to prescribe buprenorphine as OxyContin or fentanyl is essential to the fight to end the opioid epidemic in the U.S.According to Fiscella and Wakeman, less than 7% of physicians in the country currently have the DEA waivers necessary to prescribe buprenorphine.Buprenorphine and methadone are currently the only approved drug therapies for opioid addiction disorders and is considered much safer than prescription opioids used to treat pain.However, doctors and nurse practitioners must jump through extra hoops in order to obtain permission to prescribe buprenorphine, while all DEA-licensed physicians are allowed to prescribe OxyContin and fentanyl.According to the Florida Academy of Physician Assistants (FAPA), all physician assistants need only to take a three-hour course in order to obtain a DEA license allowing them to prescribe controlled substances, including opioids. In contrast, physician assistants must go through 24 hours of training in order to prescribe buprenorphine on top of the training for the standard DEA license.An increasing number of studies have found that the over-prescription of OxyContin and, more recently, the misuse of the incredibly potent opioid fentanyl together have fueled an epidemic that killed close to 50,000 people in 2017 and likely more in 2018. So why, Fiscella and Wakeman ask, is a safer opioid that is approved to treat opioid addiction more difficult to prescribe?In order to prescribe buprenorphine, medical professionals must complete extra training, apply for a specially marked license, and agree to allow the DEA to inspect their patient records. All of these extra steps both increase stigma against addiction disorders and place unnecessary barriers in front of what is widely considered to be effective treatment for this massive problem.“Patients often experience barriers trying to fill prescriptions for buprenorphine—told they cannot fill it if the “X” is missing from the prescriber’s license number—or feel shamed when filling buprenorphine prescriptions,” the authors wrote. “Some feel embarrassed telling other doctors they are taking buprenorphine.”Fiscella and Wakeman conclude that deregulating buprenorphine—essentially making it as easy to prescribe as OxyContin and fentanyl—would increase treatment rates for opioid addiction and cause deaths from overdose to plummet. They cite policy in France which implemented this kind of deregulation in 1995 and resulted in a whopping 80% decrease in opioid overdoses.“[E]ven if deregulation of buprenorphine prescribing led to ‘just’ a 50% decrease, that would mean 20,000 fewer deaths.”
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