Skip 
Navigation Link
Addictions
Resources
Basic Information
What is Addiction?What Causes Addiction?How Do You Get Addicted?Signs and Symptoms of AddictionTreatment for AddictionReferencesResourcesFrequentlly Asked Questions about Addiction
TestsLatest News
Often, Opioid Abuse Becomes a Family AffairU.S. Courts, Jails Could Be Key Players in Curbing Opioid AbuseSteep Rise in Deaths for People Hospitalized After Opioid ODRisk of Persistent Opioid Use a Concern for Youth After SurgeryFDA Approves Once-Monthly Injection for Opioid AddictionImmediate Access to Opioid Agonists Found Cost-EffectiveOpioid Crisis Hitting Boomers, Millennials HardestTop Anti-Opioid Meds Are Equally Safe, EffectiveAbusing Pot, Booze Lowers Teens' Chances for Success in LifeLethal Dangers Lurk Even After Opioid OD RescueUsing Cocaine? Fingerprints Might TellFentanyl Driving Surge in Fatal U.S. Opioid OverdosesTrump Declares Opioid Epidemic a Public Health EmergencyOpioid Addiction a Danger After Weight-Loss SurgeryU.S. Opioid Painkiller Abuse May Be Leveling OffDrug OD Rate Now Higher in Rural U.S. Than Cities: CDCExtended-Release Naltrexone Promising for Opioid DependenceHealth Tip: Recovering From Substance AbuseMedicare Could Do More to Stem Opioid EpidemicNew Online Tool Aids Search for Alcohol TreatmentHeroin Taking Bigger Share of U.S. Opioid ODsRapid Test for Meth Abuse May Be NearPost-Op Opioids: How Much Is Enough?CDC Launches Opioid Campaign in Hard-Hit StatesERs Prescribing Opioids at Lower Doses, Shorter DurationsAddictive Opioids Common for People on DialysisBooze Often Glorified On YouTube VideosOpioid ODs Have Cut Into U.S. Life Expectancy: CDCAAP: Opioid Dependence/Abuse Public Health Issue for ChildrenSurgery Can Be Trigger for Teen Opioid AbuseFDA Permits Marketing of App to Help Treat Substance AbuseApp to Help Treat Substance Abuse ApprovedFentanyl Drives Rise in Opioid-Linked Deaths in U.S.Opioid Overdoses and Deaths Flooding U.S. HospitalsIncrease in Alcohol Use, High-Risk Drinking in U.S. AdultsAlcohol Use, Abuse on the Rise in U.S.U.S. Opioid Crisis Continues to Worsen'12-Step' Strategy Boosts Success of Teen Drug Abuse ProgramAddiction Drug Underused by Primary Care Docs in U.S.7-Fold Spike Seen in Opioid-Linked Fatal Car CrashesNew Alcohol Screening, Brief Intervention Manual DevelopedOpioid Abuse Down in Younger Americans, But Up Among Older AdultsTreating ADHD May Help Curb Later Drinking, Drug ProblemsNearly 1 in 5 U.S. Adults Has Mental Illness or Drug ProblemCan Fetal Alcohol Damage Be Undone?Hospitalists Have Role to Play in Mitigating Opioid Use DisorderOpioids Second Only to Marijuana in Illicit Drug Abuse RatesEnding U.S. Opioid Abuse Epidemic Will Take Years: ReportMore Research Shows Big Surge in U.S. Opioid Use, AddictionsOpioid Addicts Find It Hard to Avoid Fentanyl
Questions and AnswersLinksBook ReviewsSelf-Help Groups
Related Topics

Anxiety Disorders
Depression: Depression & Related Conditions
Post-Traumatic Stress Disorder

Addiction Drug Underused by Primary Care Docs in U.S.

HealthDay News
by By Dennis ThompsonHealthDay Reporter
Updated: Aug 3rd 2017

new article illustration

THURSDAY, Aug. 3, 2017 (HealthDay News) -- Many doctors aren't making full use of a medication that can wean people off addiction to heroin and prescription painkillers, according to results of a new survey.

Buprenorphine is the first drug for opioid use disorder that's approved for prescription by primary care physicians, allowing treatment in the privacy of a doctor's office.

But many doctors aren't applying for the federal waiver that would allow them to prescribe buprenorphine, said researcher Andrew Huhn. He's a postdoctoral fellow with the Johns Hopkins University School of Medicine's behavioral pharmacology research unit.

Further, most who have obtained a buprenorphine waiver aren't prescribing the drug to as many patients as allowed, Huhn said.

This reluctance to fully utilize buprenorphine is hampering efforts to combat the epidemic of opioid abuse in the United States, Huhn said.

"This year is probably going to be the worst on record for overdose deaths," Huhn said. "It's possible we're going to have more drug overdose deaths this year than people that died in the Vietnam War."

More than 52,400 people died from overdose in 2015, and more than 59,000 OD deaths likely occurred in 2016, according to a recent article in The New York Times. By comparison, the U.S. military reports 58,220 personnel killed during the Vietnam War.

Buprenorphine acts upon the same brain receptors as opioid drugs, but its effects are weaker and level off even with increasing doses, according to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). This "ceiling effect" lowers the risk of misuse and addiction.

"We know when we put people on buprenorphine, the risk of overdose goes way down and the risk of relapse goes way down," Huhn said. "It is a medication that is effective at stabilizing people's lives."

Since 2002, physicians have been able to prescribe it directly after they obtain a waiver from SAMHSA, even if they aren't addiction medicine specialists, the agency noted.

"It takes eight hours to do a class, and then you get a waiver and you can prescribe," Huhn said.

Huhn and colleagues surveyed 558 U.S. physicians in 2016 to see how many had gotten this waiver and were making full use of it.

More than eight out of 10 said they have a buprenorphine waiver, the researchers found.

However, more than half with a waiver said they were not currently prescribing to capacity. SAMHSA rules at the time of the survey allowed physicians to prescribe buprenorphine to only 100 patients; this year, the cap was increased to 275.

Doctors who have a waiver but are not using it to capacity said they regularly turn away one to three patients a month who approach them for buprenorphine treatment, the researchers said.

"There are a lot of physicians who are waivered that just aren't prescribing to very many people," Huhn said.

The most common reasons given for not prescribing to capacity is that the doctor hasn't the time to take on more patients (36 percent) and inadequate reimbursement for addiction treatment services (15 percent), the findings showed.

Since the U.S. health care system is based on capitalist principles, "you do have to make the business model make sense for physicians to adopt it," Huhn said.

Nearly 55 percent of waivered doctors not prescribing to capacity indicated that nothing would increase their willingness to take as many buprenorphine patients as they can, the study authors said.

The one in 10 unwaivered doctors said they didn't want to be inundated with requests for drug treatment (30 percent) and were concerned that patients would resell the medication (26 percent).

"They kind of represent more negative attitudes toward this line of treatment in the first place," Huhn explained.

A small number of doctors who don't have a waiver or aren't using it to capacity said they wanted more information about local counseling resources, would like to be paired with another physician experienced in buprenorphine therapy, and want access to more continuing medical education courses for addiction treatment, the survey found.

Addiction treatment is very complex, and that likely is dissuading many doctors from becoming more involved in it, said New York psychiatrist Dr. Kevin Cotterell. He's with Northwell Health's South Oaks Hospital in Amityville.

"Primary care physicians have not been willing to treat patients' opioid use disorders, at least not in the numbers some expected, because their care involves so many psychosocial factors, which they don't have the time to address," Cotterell said. "They don't have the time or the training to address the spectrum of problems that are a part of addiction."

Dr. Scott Krakower, assistant unit chief of psychiatry for Zucker Hillside Hospital in Glen Oaks, N.Y., agreed. Many doctors may have "increased anxiety with how to use the agent and lack of familiarity with dosing and prescribing it," he said.

"Induction of this agent can be time-consuming and cumbersome to a practice, if enough resources are not in place," Krakower said.

Huhn presented the study Thursday at the annual meeting of the American Psychological Association in Washington, D.C. Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal.

More information

For more on buprenorphine, visit the U.S. Substance Abuse and Mental Health Services Administration.