An estimated two million people in the US struggle with opioid use disorder (OUD), and approximately 130 die from an overdose each day—but only 20 to 40 percent of people with OUD receive medications such as buprenorphine, methadone, and naltrexone to treat the condition. Increasing access to buprenorphine by making it available without a prescription could prove helpful in addressing the opioid epidemic, according to a new viewpoint co-authored by a School of Public Health researcher and published in JAMA.
“Limiting quantities to a three-day supply could encourage patients to seek long-term treatment from a clinician for their medical and psychosocial needs. But having the choice to walk into a pharmacy, any time day or night, and buy a dose of buprenorphine, rather than inject a dose of fentanyl that can kill you, seems a good option,” says Michael Stein, professor and chair of health law, policy & management, who co-authored the viewpoint with corresponding author Payel Roy, an instructor of medicine at the School of Medicine.
The Drug Addiction Treatment Act of 2000 allows physicians to prescribe buprenorphine, a schedule III medication for outpatient treatment of OUD. However, according to the authors, the steps required for patients to initiate buprenorphine treatment and for prescribers to provide buprenorphine are onerous.
“It is not surprising that many patients who require buprenorphine are unable to access this medication,” says Roy, who is also a second-year addiction medicine fellow at Boston Medical Center. “Throughout the process, patients can lose motivation and never start the treatment they need. Even after taking the necessary steps, most prescribers who receive a Drug Enforcement Agency waiver do not prescribe buprenorphine to allowable limits.”
The authors believe buprenorphine could be offered without a prescription, available behind the counter in a model similar to that used for other medications, while limiting unrestricted access by setting age and quantity limitations.
The authors concede there are several challenges and concerns for providing buprenorphine without a prescription that need to be considered, including the risk associated with taking the drug in combination with other drugs and/or alcohol, the possibility that it may become a gateway drug, the chance that it may be shared or sold, and the lost benefit of long-term physician monitoring.
“However, given the enormous burden of OUD, increased buprenorphine access could lead to reduced health costs, less drug-related criminal activity, and lower transmission rates for infectious disease, in addition to saving lives,” Roy says.