Despite widespread media and political attention directed toward people with opioid addictions, deaths from overdoses continue to happen.
In 2016, there were 42,249 deaths from opioid overdoses, a 28 percent increase from the year prior. Treating opioid use disorder had presented a challenge for primary care providers. About 80 percent of those with the disorder do not want treatment, according to an article this month in the New England Journal of Medicine (NEJM).
The article focuses, in part, on Suboxone, a drug that has become a common alternative for treating opioid addiction and one thought to be safer than methadone. Suboxone sales totaled $1.55 billion in 2013, and the drug has out-sold Viagra and Adderall, leading the New York Times to labeling it a “blockbuster” medication. Suboxone is actually a combination of two different drugs: buprenorphine (a partial opioid agonist) and naloxone (a pure opioid antagonist). Buprenorphine, as a patrial agonist, excites opioid receptors in the brain, whereas Naloxone shuts down the receptors.
The NEJM article discussed several common myths related to Suboxone, which are summarized below. Commentary is provided by Lars Reinhold, MD, MBA, and Interim Chair, Lahey Hospital Medical Center Department of Primary Care for the Region.
Myth 1: Buprenorphine is more dangerous than other interventions in primary care.
Reality: Titrating insulin, anticoagulants, and prescribing regular opiates are much more challenging than prescribing/managing buprenorphine.
Lars Reinhold, MD, MBA (LR): Personal experience is that this is exactly correct.
Myth 2: Use of buprenorphine is simply replacing one addiction with another.
Reality: Addiction is defined as compulsively using a drug despite harm. Taking buprenorphine is like taking other medications for chronic medical problems.
LR: This is a moralistic argument and has little or no place in the practice of evidence based addiction treatment.
Myth 3: Prescribing buprenorphine is time-consuming and burdensome.
Reality: Treating with buprenorphine is rewarding and not nearly as burdensome as many of the tasks and clinical work we currently consider “all in a day’s work.”
LR: In many cases it is really giving patients back their lives.
“Most patients with opioid use disorder do not receive treatment and this may be because many are not interested,” Reinhold said. “However for those that are interested, getting them enrolled in a clinic where they have access to appropriate evidence-based treatment for their disorder would be a big step in the right direction. And it can be extremely rewarding work.”