Study finds downward trend in buprenorphine abuse in U.S. adults with opioid use disorder

Data from a nationally representative survey indicates that in 2019, nearly three-quarters of American adults who reported having consumed buprenorphine did not abuse the drug in the past 12 months. In addition, the abuse of buprenorphine in people with opioid use disorders tended to decline between 2015 and 2019, despite the increase in the number of people receiving treatment with buprenorphine. The study, published today in JAMA Network Open, was conducted by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the Centers for Disease Control and Prevention.

Buprenorphine is an FDA approved drug to treat opioid use disorders and relieve severe pain. Buprenorphine used to treat opioid use disorders works by partially activating opioid receptors in the brain, which may help reduce opioid cravings, withdrawal, and overall use of other opioids.

In 2020, more than 93,000 people lost their lives to drug overdoses, with 75% of those deaths involving an opioid. However, in 2019, less than 18% of people with an opioid use disorder in the past year received medication to treat their addiction, in part because of stigma and barriers access to these drugs. To prescribe buprenorphine for the treatment of opioid use disorders, clinicians must do so as part of a certified opioid treatment program or submit a notice of intent to the federal government, and are limited as to the number of patients they can treat at the same time. Only a small proportion of clinicians are eligible to treat opioid use disorders with buprenorphine, let alone prescribe the drug.

High quality medical practice requires the provision of safe and effective treatments for health problems, including substance use disorders. This includes providing life-saving medication to people with an opioid use disorder. This study provides additional evidence to support the need for expanded access to proven treatment approaches, such as buprenorphine therapy, despite the stigma and prejudices that remain for addicts and the drugs used to treat it. “

Nora D. Volkow, MD, Director of NIDA

In April 2021, the US Department of Health and Human Services released updated buprenorphine practice guidelines to expand access to treatment for opioid use disorders. However, barriers to the use of this treatment remain, including provider unease with the management of patients with opioid use disorders, lack of adequate insurance reimbursement, and concerns about risks of diversion, abuse and overdose. Abuse is defined as patients taking medication in a manner not recommended by a doctor, and may include taking someone else’s prescription medication, or taking their own prescription in larger amounts, more frequent doses or for a longer period of time than prescribed.

To better understand the use and abuse of buprenorphine, researchers analyzed data on the use and abuse of prescription opioids, including buprenorphine, from the 2015-2019 National Drug Use Surveys. drugs and health (NSDUH). The NSDUH is conducted annually by the Substance Abuse and Mental Health Services Administration. It provides nationally representative data on prescription opioid use, abuse, opioid use disorder, and motivation for the most recent abuse among non-institutionalized U.S. civilian populations. .

Researchers found that nearly three-quarters of American adults who reported consuming buprenorphine in 2019 had not abused it in the past 12 months. Overall, around 1.7 million people reported using buprenorphine as prescribed in the past year, compared to 700,000 people who reported abusing the drug. In addition, the proportion of people with opioid use disorders who abused buprenorphine tended to decline over the study period, despite recent increases in the number of patients receiving treatment at. buprenorphine.

It is important to note that for adults with an opioid use disorder, the most common motivations for the most recent abuse of buprenorphine were ‘because I am addicted’ to opioids (27, 3%), indicating that people can take buprenorphine without a prescription for self-treatment of craving and withdrawal symptoms associated with opioid use disorder and “to relieve physical pain” (20.5% Additionally, among adults who used buprenorphine, those receiving drug treatment were less likely to abuse buprenorphine than those not receiving drug treatment. Taken together, these findings underscore the urgent need for drug abuse. expand access to buprenorphine treatment, as receiving treatment can help reduce buprenorphine abuse, and there is a need to develop strategies to continue monitoring and reducing buprenorphine abuse.

The study also found that people who had not received any drug treatment and those who lived in rural areas were more likely to abuse the drug. However, other factors, such as being a racial / ethnic minority or living in poverty, had no effect on the abuse of buprenorphine. The study authors suggested that in order to cope with the current opioid crisis, access to and quality of buprenorphine treatment for people with opioid use disorders should be improved.

“Three-quarters of adults taking buprenorphine do not abuse the drug,” said Wilson Compton, MD, MPE, deputy director of NIDA and lead author of the study. “Many people with opioid use disorders want help, and as clinicians we need to treat their disease. This study also highlights the urgent need to address racial and ethnic, health insurance, economic and geographic disparities in access to treatment, to ensure that anyone with opioid use disorder can access it. medicine that saves lives. “

Source:

National Institutes of Health

Journal reference:

Han, B., et al. (2021) Trends and characteristics of buprenorphine abuse in adults in the United States. JAMA network open. doi.org/10.1001/jamanetworkopen.2021.29409.

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