A study from the RAND Corporation noted that state policies can largely control the amount of buprenorphine distributed, a drug used to treat opioid and heroin addiction.
The researchers investigated the amount of physicians in each county nationwide who are approved to distribute the drug. They noticed a significant correlation between the amount of approved physicians and the state policies regarding the clinical distribution of the drug and its use. The findings were published in the Journal of Substance Abuse Treatment.
The role of state policies
The study authors noted that state officials who are looking to find new treatment methods for addiction to heroin and other opioids should consider policies that can help regulate the administration and use of the drug, lead study author Bradley Stein, M.D., noted.
Learning about buprenorphine
Some physicians believe buprenorphine is a better alternative to the drug methadone for helping treat opioid dependence. However, buprenorphine is more dangerous than methadone, as it is harder to control. Methadone asks patients to report daily to a supervised clinic to receive their medication. Patients are only allowed to take the medication if they have been on a well-established maintenance program for an extended period of time. Conversely, people can take buprenorphine at home like any other prescription drug.
The Substance Abuse and Mental Health Services Administration stated that methadone was first used in 1964. Buprenorphine was approved by the Food and Drug Administration in 2002.
Yet, there is only a minimal amount of the treatment. That is because the drug can only be prescribed by doctors who were given a waiver for completing special training on buprenorphine distribution. Only a small amount of physicians currently have the desired training.
Prevalence of opioid use
Heroin and opioid abuse is a current epidemic nationwide. Statistics from the Substance Abuse and Mental Health Services Administration approximated that more than 1 million Americans used illicit opioids in the past year. The organization estimated that about 2 million people are addicted to or heavily abuse opioids, including heroin and prescription drugs such as oxycodone. Both methadone and buprenorphine are approved by the federal government.
In this study, the group examined the amount of waivered physicians in each county between 2008 and 2011, while considering the population of each county in increments of 100,000. They collected data from the Buprenorphine Waiver Notification System. They found that the number of waivered physicians in a county largely depends on the county’s characteristics, the state’s policies and the push for treatment methods for heroin and opioid addiction.
The data revealed that in 2011, 43 percent of the nation’s counties had no waivered physicians and only 7 percent had 20 waivered physicians or more. The researchers found that counties with greater heroin problems had more waivered physicians. A national survey from SAMHSA found that only 5 percent of doctors were prescribing buprenorphine in 2003, but by 2011, that number shot up to 17 percent.
The study authors also found that counties with increased Medicaid funding for treatment and state guidance also had more specially trained physicians.
“There was a significant positive association between the number of waivered physicians and both specific state guidance on the use on buprenorphine and the distribution of clinical guidelines for buprenorphine treatment,” Stein said. “Policies with more-detailed guidance were associated with regions having more waivered physicians.”