Recently, there was a big announcement in the world of addiction treatment. It is related to the medication buprenorphine (also called Suboxone, Subutex, etc.). Buprenorphine is a very effective treatment for people struggling with opioid addiction. It has been shown in many research studies to prevent overdose death, decrease suffering, and allow people to return to work and be present with their families.
Prior to this announcement, prescribing this medication was restricted and access was limited. Only certain types of health providers could prescribe it and doctors needed to comply with a list of stipulations, such as completing specific trainings. While this might seem like a good idea on the surface, most of these restrictions were viewed as unnecessary, cumbersome, and expensive by those familiar with the medication.
Interestingly, stronger prescription opioids such as oxycodone, fentanyl, and hydrocodone are prescribed much more freely despite being considered more dangerous than buprenorphine. These medications are associated with a higher potential for misuse and addiction and carry a higher risk of overdose and death. Despite this, prescribers of all kinds use these medications and historically have only needed their regular license to use these medications.
As an addiction medicine physician, this contrast always felt like an example of stigma. It reinforced the idea that the treatment of addiction is harder, more inconvenient, and more dangerous than the treatment of other health conditions. The added red-tape associated with buprenorphine created even more division between the way we treat patients with addiction and the way we treat everyone else.
This division has led to bias within the medical field. I have encountered many good clinicians who assume that because buprenorphine comes with added oversight, it must be difficult to use or inherently dangerous. Those of us who use this medication know that this could not be further from the truth. Not only is buprenorphine rewarding to prescribe and easy to use, but it also allows me to truly make a difference in people’s lives. Helping individuals who are suffering with an effective and well- tolerated treatment reinforces the very reasons why I wanted to become a doctor.
Some may wonder why a specialist would want someone with less training or qualifications to be able to prescribe a special treatment that has previously been limited. While I very much value my specialty training and know that it helps me provide comprehensive and quality care to my patients, I also know that many people who are sick are not able to find someone like me in time. As a single doctor, I can only see so many patients in a day. People die because they cannot get help. Expanding access to buprenorphine will help keep people alive, which is our collective goal.
My real hope is that these changes will create a cascade. First, reducing stigma associated with use of buprenorphine. Second, reducing hesitancy among providers toward treating addiction. And third, impacting societal views about people diagnosed with substance use disorders. It is a lot to ask, but I think it is a good time to be optimistic.