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Narcan has become ubiquitous for combatting fatal opioid overdoses. However, another medication has the potential of becoming a trailblazing opioid addiction with crucial, life-saving treatment.
Buprenorphine is the first medication to treat opioid use disorder (OUD) that can be prescribed or dispensed in physician offices, according to the Substance Abuse and Mental Health Services Administration. It comes with the unique properties of binding to opioid receptors in the brain and partially activating them to eliminate intense withdrawal symptoms while reducing opioid cravings altogether.
Working as a partial opioid agonist, buprenorphine prevents a person from experiencing the full effects of other opioids if they relapse while simultaneously protecting them from overdoses.
The scope is immense. The effects of the medication increase with every dosage taken, helping individuals battle chronic pain and be able to achieve and maintain long-term recovery.
So why isn’t it more widely adopted despite being approved for clinical use since 2002?
The big picture is far more complicated. A variety of factors contribute to hesitancy on the clinical side to administer and on the patient side to adopt it.
A conversation recorded by Pew Research between Dr. Rebecca Haffajee, a professor at the University of Michigan School of Public Health, and Dr. Eric Ketcham, an emergency physician and addiction specialist with Presbyterian Healthcare System in New Mexico, reveals why buprenorphine treatment is not more readily available.
Federal legislation, the Drug Addiction Treatment Act of 2000, discourages healthcare providers from prescribing buprenorphine because it requires getting additional training and receiving permission from the Drug Enforcement Administration (also called the X-Waiver) to do so.
According to Haffejee, stigma is also a huge concern.
“Many practitioners perceive patients with OUD as a more challenging population to treat,” Haffejee explained “They may view them as untrustworthy or likely to divert the medication to others. And patients—who may struggle to find a provider even willing to treat them — are often fearful of being labeled as having an addiction, given the negative connotations often associated.”
Physicians also regularly feel like they do not have adequate support on an institutional and peer level to prescribe buprenorphine currently.
Prescribers are not required to undergo training or obtain certifications for opioids or benzodiazepines, the drugs most involved in overdoses. Addiction medicine has not been a part of standard medical education and training, and patients are suffering the consequences.
More specifically for youth opioid misuse cases, a new Oregon Health and Science research study sheds light on a troubling statistic: only one in four adolescent treatment research centers across the country provides a medication used to treat opioid use disorder, despite national overdoses rising among young people due to illicit fentanyl.
Although buprenorphine is not approved in the U.S. for people younger than 16, the American Society of Addiction Medicine recommends that buprenorphine be considered for the treatment of opioid use disorder in younger people.
“It’s the one medication that’s approved for use in adolescents, and it’s underused in facilities taking care of kids with the most severe opioid use disorder,” says Todd Korthuis, M.D., M.P.H., head of addiction medicine in the OHSU School of Medicine. “It’s hard to imagine getting adolescents with opioid use disorder off fentanyl without buprenorphine.”
“It’s a big issue,” he states. “But it’s something that we can change by supporting these treatment centers with education and technical assistance about buprenorphine, advocating for better funding to staff these centers, and by letting the public know that buprenorphine is necessary treatment in healing brains.”
In Alameda County, the matter stands to rise in urgency as the years progress, reflecting national trends for opioid overdoses. In 2023, according to a presentation to the Alameda County Board of Supervisors Health Committee, Alameda experienced 301 opioid-related overdose deaths, with an increase of 60.82% from 2022 and expected to surge in the upcoming years.
More accessible buprenorphine would provide a way for vulnerable Alameda adolescents to receive a new fighting chance at overcoming addiction long-term.
Ketcham explained how differently people view opioid addiction in comparison to traditional diseases.
“We would never stand for these mortality rates, especially among young people, if we were talking about heart disease,” said Ketcham. “We can reduce morbidity, we can reduce mortality, and we can reduce health care costs associated with OUD — but the first step is making buprenorphine readily available to those in need.”
This article was written as part of a program to educate youth and others about Alameda County’s opioid crisis, prevention and treatment options. The program is funded by the Alameda County Behavioral Health Department and the grant is administered by Three Valleys Community Foundation.
