Let’s start with some statistics. The National Institute on Drug Abuse reports that there were over 54,000 overdose deaths in 2015, easily eclipsing the record-setting number of roughly 47,000 the prior year. Nearly 35,000 of the overdose deaths in 2015 were the result of opioid drugs; and over 12,000 of those were caused by heroin. Put these figures up against the fact that roughly three percent (31,619) of the country’s 800,000-plus physicians are certified to prescribe the potentially lifesaving drug buprenorphine. Roughly 23 million Americans suffer from addiction and only a fraction of them have access to one of this critical treatment and maintenance resource.
Despite the frightening levels of overdose in this country (the pinnacle of which we thought we’d seen two years ago) and lawmakers’ promises to enact sweeping reforms to benefit addicts and their loved ones, considerable, and often insurmountable, everyday roadblocks remain for those seeking treatment. One of the most glaring examples of these obstacles is the limited availability of buprenorphine-based medications to those that need them. In 2000, federal legislation limited the cap of patients to which physicians can simultaneously prescribe buprenorphine to 100. This cap was expanded to 275 in July of last year. While this may sound like an adequate compromise, especially given institutional fear of addiction to certain buprenorphine-based medications, there are a few important things to consider.
For starters, these caps still limit access to crucial addiction treatment and prevent physicians from devoting their entire practice to opioid treatment. Because of these limits, some stable patients may be forced out of buprenorphine treatment prematurely to make room for a new patient with a more urgent need. It’s important to realize buprenorphine maintenance is an ongoing treatment and physicians run the risk of derailing patients’ progress if they take them off too early. This, however, is a choice many doctors have to make because of supply and demand. One of the trickier elements of buprenorphine treatment is that each patient’s course of care is different.
Buprenorphine has documented potential for misuse, which is why it’s been so heavily regulated; however, it’s been found to be much less addictive than its predecessor, methadone. With the rates of overdose deaths climbing literally every month, many are calling for a reexamination of these rules, asserting that patients should have every available resource at their disposal when they’re endeavoring to overcome addiction. In the meantime, research of less addictive maintenance medication options continues, and has yielded promising drugs like Vivitrol for opioid and alcohol abuse.