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Expert Says New Buprenorphine Rule Will Transform Opioid Addiction Treatment


The Biden administration is making it easier to prescribe medication to help people with opioid addiction. The drug is called buprenorphine. It reduces relapses and overdose deaths and curbs withdrawal symptoms. The new rules come as the CDC reports a spike in the number of people who died of an overdose in the U.S. - approximately 90,000 in 2020. Dr. Nora Volkow is the longtime head of the National Institute on Drug Abuse. She says no longer requiring special training and waivers for doctors to prescribe buprenorphine will transform opioid addiction treatment.

NORA VOLKOW: This is crucial because one of the roadblocks that we have had is access to treatment. There are not sufficient numbers of clinicians that are waivered to provide with buprenorphine, and this has been a major roadblock. So - and some physicians actually don't want to prescribe it because they don't want to go through the extra burden of doing the training. So this will increase the number of people that can be treated. And buprenorphine is probably one of the most effective ways that we have for preventing people from overdosing from all of the opioids that are out there in the black market, which are actually quite dangerous.

CORNISH: Can I follow up on this thing you said about medical providers not wanting to do this? - because I understand there is some stigma attached in the medical community to even treating people who are going through drug use disorders and that there was some stigma - like, kind of reluctance to use these kinds of medical treatments. How come?

VOLKOW: There's an enormous amount of stigmatization towards addiction as well as the treatments that we use to help people that are addicted. As a nation, we have criminalized substance use disorders rather than treat them. And this is one of the reasons why many clinicians don't feel it's their responsibility to take care of patients with substance use disorder. The other issue that we need to address is that the insurances do not necessarily cover for the cost of providing with buprenorphine treatment. And as a result of that, clinicians don't prescribe them. If you're not going to get reimbursed or not getting reimbursed at the level that's necessary for them to be profitable, then they don't do it. And so that's another aspect that is also has been identified as a roadblock in providing buprenorphine treatment to those that need it.

CORNISH: One challenge question I have heard is that the idea of buprenorphine is a drug that's highly diverted - right? - that it can end up off-market. What are the concerns about the relaxation of these rules contributing to that problem?

VOLKOW: Very important point. And certainly we have wanted to keep our eyes on the potential of the buprenorphine to be diverted. And, yes, there are areas where buprenorphine is highly diverted - for example, in Kentucky. But in the research, what it shows is when - they basically assess, why are people diverting or buying buprenorphine from the black market? And the main reason is actually to manage their withdrawal and to manage the craving. And one of the factors why they are reaching out is because it's very cumbersome to get access to buprenorphine prescription in a legal way.

So this is why we feel comfortable in terms of the new decision of the administration of making buprenorphine much more accessible. And it's also going to be important to, of course, observe, what are the consequences of these relaxations in the way that we are prescribing? But overall, we feel comfortable based on the knowledge that is available that most of the instances of diversion have been related to the difficulties in accessing buprenorphine for treatment.

CORNISH: Fundamentally, you've talked about the idea that, you know, insurance companies weren't paying for these drugs. Doctors didn't want to treat these patients. Do you think that the relaxation of this rule will start to change the culture around treatment itself?

VOLKOW: I think it's...

CORNISH: Like, how big a deal is this buprenorphine shift specifically?

VOLKOW: I think it is - I would like to call it a big deal because it is, again, bringing forward the treatment of opioid use disorder as for other diseases. We don't have any other medical condition where you as a doctor are told, well, by the way, you can only prescribe these medications if you go through this training, special training and you get a waiver. And by the way, you can only treat so many patients. We don't have any other medical condition. But again, addiction is deemed different.

We have been dealing with addiction with very different parameters, and that's why I call this a big deal - because it's an opening on changing the way that we are allowing clinicians to practice medicine so that it's more similar to the way that they treat other diseases. These will make it easier for clinicians to feel comfortable treating patients like - again, emphasizing - like they treat any other medical condition.

CORNISH: All right. Dr. Nora Volkow is the director of the National Institute on Drug Abuse. Thank you for your time.

VOLKOW: Thanks for your interest.

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Over two decades of journalism, Audie Cornish has become a recognized and trusted voice on the airwaves as co-host of NPR's flagship news program, All Things Considered.
Andrea de Leon
Andrea de Leon is NPR's Northeast Bureau Chief and edits the network's coverage of addiction and treatment. In her long career at NPR, de Leon has shaped coverage of Donald Trump's business and legal affairs in New York, superstorm Sandy, hurricane Katrina, and 9/11. As the editor for addiction and treatment, she has focused on the rise of the opioid epidemic, settlements with the nation's opioid manufacturers and suppliers, the patchwork of treatment for addiction in the United States, and the changing supply of illegal drugs. She is the winner of numerous awards, including the Leo C. Lee Award for her contribution to public radio journalism. She is a past member of the board of PRNDI (now the Public Media Journalists Association) and The Salt Institute for Documentary Studies.
Amy Isackson