Opioid substitute buprenorphine is never misused: Medicare report
Buprenorphine, an vital drug in preventing the opioid disaster, has lengthy been carefully monitored over issues it will be abused. However a first-of-its-kind authorities oversight report launched Thursday finds Medicare recipients hardly ever misuse the drug, which is taken into account an underused software to deal with opioid habit and stem overdose deaths.
Lower than 1% of Medicare recipients doubtlessly misused or diverted the opioid-substitute medicine in 2021, in line with the report from U.S. Division of Well being and Human Providers inspector normal investigators.
The report concluded buprenorphine is “essential to addressing the nation’s opioid disaster” however doubtless is not prescribed sufficient. Fewer than 1 in 6 Medicare enrollees who’re hooked on opioids take the medicine whilst drug overdose deaths soar.
Earlier this yr, the U.S. Drug Enforcement Administration sought to require folks to go to a physician or clinic inside 30 days of getting a telehealth prescription for managed substances equivalent to buprenorphine. Nonetheless, the DEA introduced final week it will postpone the proposal and lengthen a COVID-19 pandemic coverage permitting distant prescribing by way of Nov. 11.
HHS inspector normal analysts declined to touch upon the DEA proposal however stated Thursday’s report supplies proof that Medicare recipients hardly ever misused the drug in 2021 whereas the pandemic’s distant prescribing was in impact. Moreover, analysts say HHS ought to take steps to make buprenorphine accessible to folks with opioid-use dysfunction, significantly as greater than 100,000 folks died final yr from drug overdoses.
“Entry to buprenorphine is extraordinarily vital,” stated Miriam Anderson, a social science analysis analyst at HHS inspector normal. “It may possibly save lives and now will be broadly prescribed by many well being care suppliers.”
What’s buprenorphine?
The Nationwide Institute on Drug Abuse says folks use buprenorphine primarily to cut back cravings and ease withdrawal signs from opioids, whether or not prescription painkillers or unlawful substances equivalent to heroin or illicit fentanyl. Folks can overdose on buprenorphine, however the threat is way decrease than those that are on opioids, in line with NIDA. Medication equivalent to buprenorphine are categorized as managed substances based mostly on the potential for abuse or misuse.
How federal insurance policies on opioid substitute medicine are altering
Federal insurance policies are evolving on tips on how to stability the chance of diversion – when medicine are used or resold inappropriately – whereas making certain folks with opioid-use dysfunction can get the medicine.
Federal laws handed in 2000 required docs to register with the Substance Abuse and Psychological Well being Providers Administration and endure coaching to prescribe the medicine. Medical doctors and advocacy organizations stated the so-called “X waiver” restricted the variety of prescribers. One report discovered simply 5% of docs prescribed the drug.
However the Mainstreaming Habit Therapy Act of 2023, signed by President Joe Biden final December, eradicated the waiver requirement for docs and different clinicians who prescribe the drug. In different phrases, docs who register with the DEA are free to prescribe the medicine in the event that they select to take action.
The inspector normal stated its findings, together with the low fee of buprenorphine misuse, “help the latest repeal of the waiver.” With opioid overdose deaths close to all-time highs, the inspector normal urged HHS and the Facilities for Medicare & Medicaid Providers “use all instruments at their disposal to handle the disaster.”
How typically is buprenorphine misused?
Inspector normal investigators targeted on discovering fraud, waste and abuse in buprenorphine prescribing. Regardless of issues the drug is vulnerable to diversion, investigators discovered little proof that’s occurring.
Of the 1.1 million Medicare recipients with opioid-use dysfunction, 170,408 had been prescribed buprenorphine in 2021, of which simply 1,245 – or 0.7% – doubtlessly misused the drug attributable to excessive dosages or being prescribed opioids whereas on the substitute drug, the report discovered, together with:
- 323 had been prescribed greater than 36 mg per day of buprenorphine − greater than 50% increased than the utmost really helpful day by day dose.
- 927 obtained buprenorphine whereas they had been prescribed opioid painkillers. Getting each drugs on the identical time might imply buprenorphine was misused or sufferers had docs who didn’t coordinate care.
- 35 docs or different clinicians had irregular prescribing patterns. Of these, two docs ordered excessive dosages whereas 33 docs prescribed buprenorphine for sufferers on opioids.
What do authorities oversight investigators need to see?
The inspector normal really helpful Medicare monitor buprenorphine use and share info with different businesses and companions. This could give well being officers and a authorities committee monitoring overdoses early details about buprenorphine use, prescribing, limitations that forestall folks from getting the drug and any indicators of misuse.
In a response to the oversight suggestions, the Facilities for Medicare & Medicaid Providers stated such extra monitoring wasn’t mandatory. The company stated it already tracked drug spending and prescribing patterns that may detect potential issues. The company added that the inspector normal’s report confirmed buprenorphine misuse is low and would not increase an investigative concern.
The inspector normal additionally really helpful Medicare:
- Inform docs in regards to the low threat of buprenorphine misuse and encourage them to deal with extra folks with opioid-use dysfunction.
- Share details about variations − equivalent to Suboxone − that mixed buprenorphine with naloxone, the overdose reversal drug. These mixture medicine are much less prone to be misused.
- Evaluate and take motion on the small variety of prescribers with regarding patterns.
This research checked out Medicare. How does that translate to youthful adults?
Medicare is a federal well being program for adults over 65, nevertheless it additionally covers youthful adults with disabilities. In reality, about half of Medicare recipients with opioid-use dysfunction are youthful than 65.
The research checked out buprenorphine use amongst 50 million folks with Half D prescription drug protection. An estimated 2.1 million People have opioid-use dysfunction.
What does different analysis say about buprenorphine?
Buprenorphine overdose deaths haven’t elevated even because the drug has turn into extra broadly accessible through the nation’s habit disaster, stated Kevin Roy, chief coverage officer with Shatterproof, a nonprofit that addresses habit remedy.
He stated the inspector normal report echoes analysis that confirmed buprenorphine misuse is low.
“There is a rising physique of proof that the dangers of buprenorphine diversion are pretty restricted and offset by the advantages of entry to this remedy,” Roy stated. “Coverage must be geared towards entry to remedy each time attainable.”
Ken Alltucker is on Twitter at @kalltucker, or will be emailed at alltuck@usatoday.com
