Baltimore—Just because patients are receiving medication-assisted interventions for opioid addiction doesn’t mean they aren’t receiving narcotic painkillers during or after treatment.
So reports a new study in the journal Addiction, which found that more than two in five people receiving buprenorphine, a drug commonly used to treat opioid addiction, are also given prescriptions for other opioid painkillers.
Furthermore, according to the study team led by researchers from the Johns Hopkins Bloomberg School of Public Health, two-thirds are prescribed opioids after their treatment is complete. The researchers maintain that their study underscores the need for greater resources devoted to medication-assisted treatment, a common clinical tool to address the opioid epidemic.
While methadone was primarily used for medication-assisted treatment in the past, over the last 15 years, buprenorphine, a shorter-acting opioid similar to methadone, has been increasingly employed, at least partly because it can be prescribed in a physician’s office and doesn’t usually require a special clinic.
“Policymakers may believe that people treated for opioid addiction are cured, but people with substance use disorders have a lifelong vulnerability, even if they are not actively using,” explained study leader G. Caleb Alexander, MD, MS, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health and the co-director of the School’s Center for Drug Safety and Effectiveness. “Our findings highlight the importance of stable, ongoing care for these patients.”
The study team examined Quintiles IMS pharmacy claims for more than 38,000 new buprenorphine users who filled prescriptions between 2006 and 2013 in 11 states. The researchers looked at nonbuprenorphine opioid prescriptions before, during, and after each patient’s first course of buprenorphine treatment, which typically lasted between 1 and 6 months, focusing on number of prescriptions, quantity dispensed, days of supply and total morphine milligram equivalents (MME) before, during and after the first treatment episode.
Results indicate that 43% of patients who received buprenorphine filled an opioid prescription during treatment, and 67% filled an opioid prescription during the 12 months following buprenorphine treatment. The mean total of MME per opioid day supplied 12 months prior to treatment declined from 57 mg/day to 54 mg/day during the treatment episode, then remained constant at 55 mg/day following the treatment episode.
“The statistics are startling,” Alexander emphasized, “but are consistent with studies of patients treated with methadone showing that many patients resume opioid use after treatment.” The study might even have underestimated the proportion of patients using opioids concurrent with or after buprenorphine treatment, because it did not include information on use of illegal opioids such as heroin, study authors add.
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