Determining Whether to Expand Prescribing Buprenorphine for Opioid Abusers

Though buprenorphine can be abused, many experts believe prescribing should expand but include more safety guidelines.

There is much debate surrounding the drug buprenorphine. Though it has become an essential part of treatment for opioid abusers, it also has the potential to be misused.

In a study published in the Journal of Psychiatric Practice, experts discuss the issue at-hand and proposed strategies to promote the proper use of buprenorphine, while ensuring quality of care and reducing the risk of abuse.

Compared with methadone use for opioid and heroin addiction, buprenorphine has a lower risk of diversion and abuse. The most commonly prescribed form of this drug is naloxone, which decreases the potential of intravenous abuse.

There are currently strict rules for prescribing buprenorphine. Physicians must receive a DEA waiver, complete special training, and comply with limits on the number of patients they can treat with the drug. This results in approximately 53% of US counties not having a physician who can prescribe the drug.

Researchers express a concern about intravenous buprenorphine abuse, however.

"This real-world, almost paradoxical, phenomenon demonstrates the complexity inherent in the treatment of addictive disorders--a medication intended to treat substance use disorder that has its own abuse potential, upon gaining popularity and increased availability, will inevitably be explored by drug abusers for reward and reinforcement purposes,” the researchers wrote.

In order to safely expand prescribing of this drug, researchers believe there should be additional support given for certain physicians with many patients. Additional measures to help the prescribers meet guidelines should be given as well, according to the study.

Another suggestion was that medical education specifically targeting improvements for in office-based therapy for opioid abuse should be continued, the study noted.

Strict policies and regulations should be in place to promote safe practice by physicians, while financial incentives should be given with enforcement of safe practice.

Supervised dispensing and more pharmacy involvement should be practiced. Lastly, the researchers said that high-risk groups should be identified.

"The question is not whether or not to expand buprenorphine prescribing. It is how to expand buprenorphine prescribing safely and effectively,” the researchers concluded.