Buprenorphine, a major drug in the fight against the opioid crisis, has long been closely monitored for fears it could be overused. But a first-of-its-kind government oversight report released Thursday finds that Medicare recipients rarely abuse the drug, which is considered an underutilized tool for treating opioid addiction and curbing overdose deaths.
Fewer than 1 percent of Medicare beneficiaries potentially abused or diverted to opioid substitution medication in 2021, according to the US Department of Health and Human Services Inspector General’s Investigator General’s Report.
The report concluded that buprenorphine is critical to addressing the nation’s opioid crisis, “but it’s probably not being prescribed enough. Less than 1 in 6 Medicare enrollees who are addicted to opioids are taking the drug even as overdose deaths rise dizzyingly.
Earlier this year, the US Drug Enforcement Administration sought to require people to visit a doctor or clinic within 30 days of obtaining a telehealth prescription for controlled substances like buprenorphine. However, the DEA announced last week that it would defer the proposal and extend a COVID-19 pandemic policy that allows remote prescribing through Nov. 11.
HHS Inspector General analysts declined to comment on the DEA’s proposal, but said Thursday’s report provides evidence that Medicare recipients rarely misused the drug in 2021 while the pandemic’s remote prescribing was in effect. Additionally, analysts say HHS should take steps to make buprenorphine available to people with opioid use disorder, particularly as more than 100,000 people died from drug overdoses last year.
Access to buprenorphine is extremely important, said Miriam Anderson, a social science research analyst at the HHS Inspector General. It can save lives and can now be widely prescribed by many healthcare professionals.
What is Buprenorphine?
The National Institute on Drug Abuse says people use buprenorphine primarily to reduce appetite and relieve withdrawal symptoms from opioids, whether they’re prescription pain relievers or illegal substances like heroin or illicit fentanyl. People can overdose on buprenorphinebut the risk is much lower than for those taking opioids, according to NIDA. Drugs like buprenorphine are classified as controlled substances based on the potential for abuse or misuse.
How federal opioid substitution drug policies are changing
Federal policies are evolving on how to balance the risk of diversion when drugs are inappropriately used or resold while ensuring that people with opioid use disorder can get the drug.
Federal legislation passed in 2000 required doctors to register with the Substance Abuse and Mental Health Services Administration and undergo training to prescribe the drug. Doctors and advocacy organizations said the so-called “X waiver” limited the number of prescribers. One report found that only 5% of doctors prescribed the drug.
But the Mainstreaming Addiction Treatment Act of 2023, signed into law by President Joe Biden last December, eliminated the waiver requirements for doctors and other clinicians who prescribe the drug. In other words, doctors who register with the DEA are free to prescribe the drug if they choose to.
The inspector general said his findings, including buprenorphine’s low abuse rate, “support the recent repeal of the waiver”. With opioid overdose deaths nearing an all-time high, the inspector general urged HHS and the Centers for Medicare and Medicaid Services “to use every tool at their disposal to address the crisis.”
How often is buprenorphine abused?
The Inspector General’s investigators focused on finding fraud, waste and abuse in the prescribing of buprenorphine. Despite concerns that the drug is subject to diversion, investigators have found little evidence that it is occurring.
Of the 1.1 million Medicare recipients with opioid use disorder, 170,408 were prescribed buprenorphine in 2021, of whom only 1,245 or 0.7 percent potentially misused the drug due to high doses or prescribed opioids while taking the replacement drug, according to the report, including:
- 323 were prescribed more than 36 mg of buprenorphine per day, more than 50% more than the maximum recommended daily dose.
- 927 received buprenorphine while prescribed opioid painkillers. Getting both drugs at the same time could mean buprenorphine was misused or patients had doctors who didn’t coordinate care.
- 35 physicians or other clinicians had abnormal prescribing patterns. Of these, two physicians prescribed high dosages while 33 physicians prescribed buprenorphine to patients taking opioids.
What do government oversight investigators want to see?
The inspector general has recommended that Medicare monitor buprenorphine use and share information with other agencies and partners. This would provide health officials and a government committee that monitors overdoses with timely information about buprenorphine use, prescribing, barriers to people getting the drug, and any signs of misuse.
In response to the oversight recommendations, CMS said such additional monitoring was unnecessary. The agency said it has already monitored drug spending and prescribing patterns that can detect potential problems. The agency added that the Inspector General’s report showed buprenorphine abuse was low and raised no investigative concern.
The inspector general also recommended to Medicare:
- Educate doctors about the low risk of buprenorphine abuse and encourage them to treat more people with opioid use disorder.
- Share information about releases like Suboxone that combined buprenorphine with the overdose drug naloxone. These combination drugs are less likely to be misused.
- Investigate and act on the small number of prescribers with patterns of concern.
This study looked at Medicare. How does that translate for young adults?
Medicare is a federal health care program for adults over 65, but it also covers young adults with disabilities. In fact, about half of Medicare beneficiaries with opioid disorder are under the age of 65.
The study looked at buprenorphine use among 50 million people with Part D prescription drug coverage. An estimated 2.1 million Americans have opioid use disorder.
What does other research say about buprenorphine?
Deaths from buprenorphine overdose have not risen even as the drug has become more widely available during the nation’s addiction crisis, said Kevin Roy, chief policy officer of Shatterproof, a non-profit organization that focuses on the treatment of buprenorphine. dependence.
He said the Inspector General’s report echoes research that has shown buprenorphine abuse is low.
“There is a growing body of evidence that the risks of buprenorphine diversion are quite limited and outweighed by the benefits of accessing this treatment,” Roy said. “Policy should be geared towards access to care whenever possible.”
Ken Alltucker is on Twitter at @kalltucker or can be emailed to alltuck@usatoday.com
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