One is that we can help make the choice easier between illicit fentanyl or buprenorphine when people are feeling sick from opioid withdrawal. To me, this upside and the possibility of reducing overdose deaths mitigate my real concerns about this new idea.

Most heroin and fentanyl and prescription pill users use multiple times every day, whereas buprenorphine is long-lasting, requiring a single dose daily, limiting exposure to potentially lethal illicit opioids. Stein: When every dose of heroin or fentanyl could kill you, having immediate access to buprenorphine at a pharmacy-morning or evening-could be lifesaving. What could be the biggest benefit of having buprenorphine available behind-the-counter? This allows the addicted brain to slowly begin to recover from all the highs and lows of illicit opioid use so people are in a more “normal,” steady state. Methadone and buprenorphine work because they can activate the same receptors that more addictive opioids like heroin and fentanyl activate, but without causing a euphoria. Illicit opioids like heroin and fentanyl can cause addiction because they induce a euphoria very quickly, as well as an associated “low,” or withdrawal state, which causes people to want to use more.

Opioid-based medications have some of the best efficacy for treating people with opioid addiction long term. Roy: There are several treatments we use to help people with opioid addiction, including medications such as buprenorphine, methadone, and naltrexone, as well as behavioral interventions such as psychotherapy, Narcotics Anonymous, and other methods. Why is opioid use disorder treated with an opioid-based medication? To prescribe buprenorphine in particular, providers need to obtain a specific waiver from the Drug Enforcement Agency, which can bias many well-meaning clinicians into thinking that prescribing buprenorphine is too complicated or advanced for their practice. If trying one or two of the three available medications isn’t effective, I don’t have many other options to treat my patients.įor providers who do choose to treat patients with opioid use disorder, there are significant regulations around treatment. Stigma gets in the way, but we also simply do not have enough treatment options for people. Medical providers often exhibit stigma related to patients with opioid addiction, too, making it difficult for patients to trust the treatment community. So, medications to treat this disease should be the first-line treatment, as we know that it is extremely difficult to quit on one’s own. The current research around addiction has suggested that addiction is a chronic disease–just like high blood pressure and diabetes. People feel that they are “still addicted” if they use opioid-based medications like buprenorphine as treatment, and prefer to try to stop on their own through meetings and groups. When it comes to patients, there is still a lot of stigma around medications used to treat opioid use disorder. Q &A With Payel Roy and Michael Stein The Brink: Why do so few individuals with opioid use disorder have access to medications like buprenorphine in the first place? Roy and Stein spoke with The Brink to tell us more about why they think behind-the-counter buprenorphine could make a difference for people who are suffering from opioid withdrawal and don’t want to relapse to using drugs like heroin or fentanyl or painkillers like oxycodone. Stein, chair of BU’s School of Public Health department of health law, policy and management, provides primary care and buprenorphine treatment at a clinical practice in Rhode Island, which in 2003 was the first clinic in the state to start prescribing buprenorphine. Roy, a Boston University School of Medicine addiction medicine fellow and an internist at Boston Medical Center, sees patients every day who are struggling with opioid use disorder. But what if treatment was within reach without a visit to the doctor’s office? Boston University addiction experts Payel Roy and Michael Stein argue in a new editorial published in JAMA that lives could be saved by making one of these three medications, buprenorphine, more accessible to patients as a behind-the-counter drug monitored and administered by pharmacists. Methadone, naltrexone, and buprenorphine are all opioid-based medications and require a prescription for use, which can make them difficult to obtain for people who urgently need them to avoid relapse. As of now, there are only three medications approved by the Food and Drug Administration to treat opioid use disorder, a disease affecting an estimated two million individuals in the United States.

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