The United States is in the midst of an opioid epidemic, with millions of people suffering from opioid addiction along with an unprecedented number of opioid overdoses and about 50,000 opioid-related deaths per year. What these numbers do not tell is the true impact it has on the individuals who are suffering from opioid addiction, their families, their communities and to the greater impact it has on society as a whole: withdrawal symptoms, depression, criminal justice involvement, lost wages and productivity, the cost of addiction treatment, just to name a few.
While recently the COVID-19 pandemic has dominated most of the media coverage, the opioid epidemic has not suddenly disappeared. In fact, because of the impact that the coronavirus has on in-person doctors’ offices and addiction clinics, many patients relying on addiction treatment suddenly found themselves lost, without any ability to get help.
What is Medication-Assisted Treatment (MAT)?
One of the most successful strategies to treat patients suffering from opioid use disorder (OUD) consists of medication-assisted treatment (MAT) in combination with cognitive behavioral therapy (counseling). One of the most effective and safest medications used for MAT is ‘buprenorphine’ and its combination products (usually combined with naloxone). It has been shown to treat withdrawal symptoms, cravings, while at the same time preventing overdoses and deaths related to opioid use. When prescribed correctly, it has been shown to not affect the job performance or the cognitive brain functions of an individual.
While methadone is also considered MAT, it has several disadvantages: because it is a full opioid-agonist it causes more drowsiness and requires almost daily administration at a methadone clinic and among other reasons is therefore slowly falling out of favor. Buprenorphine on the other hand is only a partial opioid (while at the same time being an opioid antagonist) which means that it can be self-administered by the patient after a consultation with an addiction specialist who is licensed to prescribe buprenorphine.
What is Tele-MAT?
According to the Pew analysis, 88.6% of rural counties lack adequate access to medication-assisted treatment programs. And with no end in sight to the opioid crisis and now the overlap with the COVID-19 pandemic, this causes an even further limitation of access to MAT. The DEA recognizes this emergency and now allows addiction specialists to prescribe buprenorphine via phone or video, without the need for an initial in-person visit.
Is it safe to be prescribed buprenorphine via the internet?
In an ideal system, every patient should have access to an in-person doctor at any time and an in-person doctor-patient relationship is preferable than consulting with a specialist via video. However, the reality is that a majority of the country does not have access to MAT, which likely causes thousands of premature deaths.
In response to the Covid-19 crisis in early 2020, the DEA has announced that practitioners can now prescribe buprenorphine to patients using telemedicine without the need to conduct an initial in-person evaluation. This means that as long as a doctor deems that a patient is a suitable candidate to receive buprenorphine after a video or telephone consultation, that doctor can begin to prescribe that medication to that patient.
This comes as a huge relief to people suffering from opioid use disorder who have been hoping for a confidential and convenient way to receive treatment.
How do I prevent myself from being taken advantage of?
Patients with opioid use disorder are particularly vulnerable to being taken advantage of, and there are many unethical addiction services around that would not hesitate to exploit them. Because of these bad players, it can be quite challenging to find addiction services that can offer quality services.
One way to research addiction services is to ask reputable sources, like the SAMHSA (https://www.samhsa.gov/find-help/national-helpline), the American Society of Addiction Medicine (https://www.asam.org/Quality-Science/resource-links/patient-resources), reach out to NA (Narcotics Anonymous) meetings in your area (https://www.na.org), check reviews, and make sure they are verified by a reputable certification service, like LegitScript (https://www.legitscript.com/). This certificate is only given to addiction centers that have been independently verified.
What is the difference between Suboxone, buprenorphine, and Subutex?
First of all, buprenorphine and Subutex are the same things – Subutex is simply the brand name for the drug buprenorphine. Suboxone, on the other hand, is the brand name for the combination of the drugs buprenorphine and naloxone.
What does this all mean? Well, buprenorphine (or Subutex) is a single drug, while Suboxone is a combination drug (consisting of buprenorphine and naloxone). Most of the time, doctors will prescribe the combination drug. This is because naloxone, on itself, barely gets absorbed and usually has no effect unless the medication is injected. To minimize the risk of illegal diversion, overwhelmingly the combination medication is prescribed by addiction specialists, and only in rare instances will the mono-product be considered.
What are the side effects of buprenorphine?
Like all medications, buprenorphine can produce side effects in patients. Among them are headaches, tiredness, loss of appetite, constipation, skin rashes, weight gain, lowering of sex drives, and changes to periods (in women). Consult your doctor if you experience any of these side effects.
What about drug testing?
Drug testing is not required in most states to be started on buprenorphine. Drug testing may lead to an additional barrier for some patients to receive access to often life-saving medication, areas it delays treatment, may pose logistical problems, or simply may be too expensive. Drug testing may be required if someone has been prescribed buprenorphine alone instead of the combination medication.
If you or a family member are struggling with opioid drug addiction, do not wait to reach out for help. You may contact one of the resources mentioned above, or if you feel ready to be started to buprenorphine or would like to continue treatment, talk to one of our addiction specialists, 7 days a week.