Experts say the supply of drugs is riskier than ever. Illegal drugs can be contaminated with many dangerous substances, making them more unpredictable and raising the risk of overdoses.
Effective treatments are dependent on the risks. According to a new study published in the journal Drug and Alcohol Dependence, buprenorphine is hard to get at most pharmacy.
Buprenorphine, a drug that has been shown to reduce the risk of dying from opiate overdoses, was readily available in less than half of the states that researchers called. Some states were less available than others. In California, buprenorphine was the least available, and in Maine, it was the most popular. The study found that Narcan, the drug used to reverse the effects of an overdose, was only available in 70% of the stores surveyed.
According to Lucas Hill, director of the pharmacy addictions research and medicine program at the University of Texas at Austin, the results suggest that many health-care professionals don't see buprenorphine as a life-saving treatment. He says it's frustrating to see health professionals still see buprenorphine as an optional part of their practice. Due to the poisoning of the illegal drug supply, buprenorphine is the best tool to help people with opiate use disorder.
Many patients with opiate use disorder prefer buprenorphine, which is a combination of buprenorphine and naloxone, over the other two drugs, naltrexone and methadone. Buprenorphine can be prescribed outside of an addiction program. It's easier to start treatment with naltrexone than it is with other drugs. Patients are less vulnerable to an overdose if they use an opiate.
Buprenorphine has been tightly regulated since it was first approved for use in the treatment of opiate use disorder. The US Drug Enforcement Administration has cracked down on pharmacies that fill a lot of prescriptions for buprenorphine. A license called an X-waiver is required for doctors to prescribe buprenorphine. X-waivers are used to cut patients off from treatment.
Three trends were found that predicted whether a pharmacy would carry buprenorphine. National chains are more likely to carry it. In states where overdose deaths are more common, as well as in states that have expanded Medicaid, it is more likely to be found in the pharmacy. California expanded Medicaid but still has less buprenorphine access than most other states.
Independent drugstores are reluctant to carry buprenorphine because they are concerned that filling too many prescriptions of the drug may lead to a Drug Enforcement Administration investigation. Buprenorphine wholesalers have to flag suspicious orders to the Drug Enforcement Administration. According to Taleed El-Sabawi, an assistant professor of law at Florida International University College of Law who studies addiction, the Drug Enforcement Administration should issue official guidelines for the distribution of buprenorphine to make it clear that they can give it to patients without repercussions. According to El-Sabawi, the pharmacy is afraid of the Drug Enforcement Agency.
There may not being enough demand for the drugs, which could expire on a shelf and cost the pharmacy money, is one concern that some of them have. There is a stigma against people with opiate use disorder.
Hill believes that buprenorphine should be made available to people who need it. He says that if you aren't sure, the answer is always to give it a try.
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