(Reuters Health) – Less than one in ten primary care providers in the US can prescribe buprenorphine, an opioid addiction drug, and access is even rarer in rural areas suggests that the counties are hardest hit by overdoses.
Since 2000, physicians have been able to request the federal government to stop prescribing buprenorphine, which is considered an alternative to methadone, which is available in state-approved clinics, said co-author Ryan McBain of the RAND Corporation in Boston , More recently, nurses and medical assistants have been allowed to request a waiver, which has quadrupled the number of doctors across the country who could prescribe buprenorphine.
From 2007 to 2017, the number of providers who did not prescribe buprenorphine rose from 3.8 to 100,000 inhabitants to 17.3 per 100,000, researchers in Annals of Internal Medicine report. Still, fewer than 10% of primary care providers could prescribe the drug by the end of the study period.
"Over the same period, opioid deaths rose from approximately 16,500 a year to 46,000 a year," McBain said by email. "So we see that the need for treatment is also increasing."
As of 2017, almost 95% of the doctors who did not prescribe buprenorphine were doctors. About 4% were nurses and about 1% were medical assistants, which analysis of government data showed.
Among the individuals with exemptions, 72% were approved for the treatment of up to 30 patients, while 22% could treat a maximum of 275 patients and 6%.
The number of doctors who could prescribe buprenorphine rose fastest in communities with the highest number of deaths from opioid overdose per capita. In communities with the most overdose deaths, the proportion of providers who refused approval increased five-fold, while it increased three-fold in places with the least overdose deaths.
Even after researchers identified needs based on overdose death rates, they found that rural districts did not attract as many providers who were able to prescribe the drug.
Districts with more college graduates won more providers who could prescribe buprenorphine than communities with fewer college graduates.
Researchers lacked data on how many prescription doctors with exceptions actually wrote or how many patients they treated.
Nevertheless, the results suggest that access to buprenorphine does not keep pace with needs, said Dr. Stefan Kertesz from the University of Alabama at the Birmingham School of Medicine.
"The type of doctor that most people actually see is prohibited by law to offer the most accessible and effective form of opioid addiction treatment," Kertesz, who was not involved in the study, said via email , "The fact that most of our healthcare workers are unwilling to treat a devastating and treatable disease is a tragedy that we need to fix."
Other medication options include methadone, which is only available through licensed clinics, and naltrexone, which any doctor can prescribe, but many don't know how to use it, Kertesz said.
These hurdles for people with opioid use disorder do not occur in patients with other chronic health problems, said Dr. Pooja Lagisetty from the University of Michigan Medical School and the VA Ann Arbor Healthcare System.
"For other diseases, we meet patients where they are and adapt the treatment to their preferences and needs," Lagisetty, who was not involved in the study, said via email.
There are a dozen drug treatments for many chronic diseases, she added.
"But we have three with opioid use disorder," Lagisetty said. "With so few options, we have to make them available to all patients, not just those living in certain communities."
SOURCE: bit.ly/2sRKAX6 Annals of Internal Medicine, online, January 6, 2019.
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