Many people addicted to opioids struggle to access treatment. However, recent policy changes enacted by the U.S. Drug Enforcement Administration (DEA) could make this care easier to obtain, particularly in rural areas where there is often a shortage of physicians.
The DEA made a three-year pilot program allowing nurse practitioners (NPs) and physician assistants (PAs) to prescribe buprenorphine permanent. This opens the door for more mid-level practitioners, including those in solo practices in rural communities, to help address the opioid crisis. Currently, about 5,000 NPs and PAs can prescribe buprenorphine. The change in policy could increase that number to 25,000 according to the American Society of Addiction Medicine.
How Is Buprenorphine Used with Medication-Assisted Treatment?
Buprenorphine is a drug used with medication-assisted treatment (MAT) that has been extremely successful in helping people manage opioid cravings and ward off symptoms of withdrawal. As with all medications used in MAT, buprenorphine is prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs.
Treatment occurs in three phases:
1. The Induction Phase: Buprenorphine is first administered when a person with an opioid dependency has abstained from using opioids for 12 to 24 hours and is in the early stages of opioid withdrawal. Treatment begins this way because buprenorphine can bring on acute withdrawal for patients who are not in the early stages and who have other opioids in their bloodstream.
What Is Buprenorphine?
Buprenorphine (Suboxone, Zubsolv) helps prevent withdrawal symptoms that develop after stopping other opioids. It is a combination medication that also contains naloxone, a drug used to reverse an opioid overdose. Naloxone blocks the effects of narcotics. It is combined with buprenorphine to prevent abuse and misuse of this medication.
2. The Stabilization Phase: Once a patient no longer has cravings and side effects, the buprenorphine dose may be adjusted. Patients sometimes switch to alternate-day dosing instead of dosing every day.
3. The Maintenance Phase: Once a patient is doing well, a maintenance program is set up. Some patients choose a medically supervised withdrawal and then engage in further rehabilitation – with or without MAT – to prevent a possible relapse. Maintenance treatment can be indefinite.
Unlike methadone, which must be administered in a controlled setting, buprenorphine can be dispensed from a storefront clinic. However, buprenorphine is an opioid, and while less potent than other opiates, it can be addicting and its use must be supervised. Until the DEA ruling, the only health care workers (outside of the pilot program) who could prescribe buprenorphine were doctors who had obtained a special waiver from the DEA. Most of these physicians (90 percent) work in urban areas.
Rural Communities in Crisis
According to the National Rural Health Association, more than half of rural counties do not have any doctor who can prescribe buprenorphine. Thirty million people live in counties where treatment is unavailable. Patients from these communities have had to travel long distances to access treatment for addiction. The result is that 80 percent do not get the medical care they need. Today, the rate of drug overdose deaths is higher in rural America than in urban areas.
With more medical professionals able to prescribe buprenorphine, the expectation from the DEA is that deaths from overdoses will decrease and that people who are addicted to opioids will be able to get the treatment they need and lead productive lives.
Finding Help and Getting Treatment
Resources may be available through your Local Union, LIUNA health and welfare fund, employer or your community. Check to see if you have access to a Member Assistance Program (MAP) through your employer or LIUNA health and welfare fund. MAPs are designed specifically to assist with drug and alcohol issues.
As with all medical care, we suggest checking with your LIUNA health and welfare fund and/or your insurance provider to verify coverage and benefits related to opioid treatment and what steps, if any, need to be taken before accessing care.
The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains a search tool on its website to locate nearby treatment centers based on a person’s address and other requirements. SAMHSA’s free, confidential national helpline for individuals and family members facing substance abuse and mental health issues is also available 24 hours a day, seven days a week at 1-800-662-HELP and 1-800-487-4889 (TTY).
The LHSFNA has developed a number of materials to help those struggling with addiction. These include the Opioid Abuse & Addiction and Prescription Drug Addiction Health Alerts and the It’s Your Choice When You Know the Facts about Drugs and Alcohol pamphlet. To order these and other health and safety materials, go to www.lhsfna.org and click on Publications. For more information, call the Fund’s Health Promotion Division at 202-628-5465.
[Janet Lubman Rathner]