BILLIONThe oday’s supply of illegal drugs is becoming more risky than ever, experts say. It is often contaminated with various dangerous substances — from strong opium fentanylto the horse tranquilizer xylazineto benzodiazepines — making illicit drug use more unpredictable and increases the risk of overdose.
These risks make effective treatments indispensable. However, one of the most successful treatments for opioid dependence — buprenorphine — is hard to come by in most pharmacies nationwide, according to a newly published study. in the magazine Dependence on drugs and alcohol.
Researchers made secret shopper phone calls to nearly 5,000 pharmacies in 11 states between 2020 and 2021 and found that buprenorphine, a proven opioid addictive drug to be halves The risk of death among ready-made opioid users is less than half of them. Some states have worse availability than others. In California, which has the least amount of buprenorphine, only 31% of pharmacies carry it, while in Maine, where it has the most, 86% of pharmacies have it. The study also found that naloxone, which reverses the effects of an overdose and is sold as a nasal spray as Narcanonly in 70% of pharmacies surveyed.
Study co-author Lucas Hill, director of the opiate addiction research program at the University of Texas at Austin College of Pharmacy. “It is disheartening to see medical professionals of all types continue to make buprenorphine an optional part of their healthcare practice,” he said. “Buprenorphine is our best tool to help people with opioid use disorders at risk of dying from today’s toxic opioid overdose.”
Buprenorphine, commonly distributed under the brand name Suboxone (a combination of buprenorphine and naloxone) is important to many patients with opioid use disorders and is often preferred over the two other medications currently available, methadone and naltrexone. Unlike methadone, buprenorphine can be legally prescribed outside of an opioid treatment program. And compared with patients on naltrexone — a drug that blocks the effects of opioids — it was easier to get started, because patients no need to detox before starting treatment. It also allows patients to maintain an opioid tolerance, making them less likely to overdose if they later use an opioid.
Despite its effectiveness, it has come under scrutiny since it was first approved for opioid use disorder 20 years ago — in part because buprenorphine is itself an opiate and has potential potential for abuse. The US Drug Enforcement Administration (DEA) recently cracked There are many prescriptions in pharmacies for buprenorphine, a controlled substance. Physicians and other clinicians who wish to prescribe buprenorphine to their patients must obtain a special authorization, known as an X-waiver. But less than 10% doctors there’s X-waiver, which advocates say cuts many patients off treatment.
Hill’s study revealed three trends that predict whether a pharmacy is likely to supply buprenorphine. Large nationwide chains are more likely to stock it than independent pharmacies. It is also more likely to be sold in pharmacies in states that have expanded Medicaid, as well as in states where opioid overdose deaths are more common. (There are some exceptions; California, for example, has expanded Medicaid but still has less access to buprenorphine than most other states.)
Some independent pharmacists reported being reluctant to carry Buprenorphine because they were concerned that over-prescribing could trigger a DEA investigation. Buprenorphine wholesalers must flag large or suspicious orders to the DEA. Taleed El-Sabawi, an assistant professor of law at Florida International University College of Law who studies addictions, argued that the DEA should issue official guidance on dispensing buprenorphine so that pharmacists know that they were able to supply it to patients without compromise and directed a campaign promoting the distribution of buprenorphine directly to pharmacies that did not sell the drug. “DEA is feared by pharmacists,” said El-Sabawi.
Some pharmacists also worry that there may not be enough demand for the drug, which could expire on the shelves and cost them money, Hill said. Another deterrent, he said, is the persistent stigma against people with opioid use disorders.
In the midst of such an overdose crisis, Hill thinks pharmacists should put aside their doubts and make buprenorphine available to those who need it. “If you’re not sure, the answer is always in favor of drug delivery,” he says, “because it’s a life-saving drug.”
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