With more than 4.5 million people dependent on opiates in the United States, the issue of opiate addiction has caught the attention and concern of government and health organizations. In a paper published today in the Journal of Psychiatric Practice®, experts at Baylor College of Medicine highlight the need to expand the use of buprenorphine as a treatment agent and discuss the need for additional resources for physicians.
“Buprenorphine is an opiate drug that, at low doses, relieves pain but in contrast to other opiates, at higher doses it starts to block opiates, including itself,” said Dr. Thomas Kosten, Jay H. Waggoner Endowed Chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor . “It is almost impossible to overdose on buprenorphine, and if you give dosages above four milligrams per day, it can block people from getting high, becoming addicted or dying from opiate overdose.”
According to Kosten, who is also with the Michael E. DeBakey Veterans Affairs Medical Center in Houston, the most effective treatment for opiate dependence is maintenance on a stabilizing agent such as buprenorphine or methadone. Buprenorphine can be used to treat individuals who have become opiate dependent and addicted. When discontinued, it does have a withdrawal syndrome, but one that is significantly less severe than other opiates such as methadone, morphine or oxycodone, said Kosten.
However, in order to prescribe this as a treatment for dependence, physicians must have the proper certification. Initially, physicians can prescribe for up to 30 patients and then after one year, 100 people. Kosten and colleagues note that too few physicians who have the certification, about 44 percent, are actually prescribing or are prescribing for less than five patients. Kosten notes that current regulations should be amended so that physicians who have the qualifications can prescribe to more patients.
The paper also highlights the idea that nurse practitioners or physician assistants under the supervision of a certified psychiatrist could also be responsible for prescribing to up to 80 patients at a time.
“We need more physicians to prescribe buprenorphine and fewer physicians prescribing short-term opiates for long periods of time,” said Kosten.
Kosten and colleagues also caution that expanding buprenorphine prescribing needs to be done safely and effectively. For example, the recent emergence of intravenous buprenorphine abuse is of concern.
Others involved in the paper include Drs. Xiaofan Li and Daryl Shorter, both with Baylor College of Medicine.