Early in August, the US Food and Drug Administration (FDA) approved a sixth medication for reversing opioid overdoses. The product, call Zurnai, is an automatic injection of the drug nalmefene, produced by Purdue Pharma 鈥� the same pharmaceutical company that helped fuel the opioid crisis.
Irony aside, this is 鈥� at least at face value 鈥� a welcome addition to the growing arsenal of medications meant to combat the opioid crisis. Nalmefene is stronger and has a longer duration than its more common counterpart naloxone, which has become less effective against an increasingly potent illicit drug supply. But in practice, it will do little, if anything, to stem an epidemic that killed more than in the US last year alone. That is because so long as people continue using opioids, they continue to .
To stop opioid overdoses and deaths, we must treat the root cause of the crisis: addiction. And we have the tools to do it.
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Medications for opioid use disorder (MOUD), such as buprenorphine and methadone, are the most effective treatment for opioid dependence. They work by fully or partially binding to opioid receptors in the brain without producing a high, but still easing cravings and withdrawal symptoms. These drugs are linked to an almost , and people taking them are less likely to use opioids like morphine or heroin and more likely to stay in treatment than those who aren鈥檛.
The issue is that of people with an opioid use disorder in the US aren鈥檛 receiving these medications, and healthcare providers rarely offer them. For instance, a study published in June analysed outcomes in more than 136,000 people hospitalised with a non-fatal drug overdose and found that while more than 17 per cent of them were diagnosed with an opioid use disorder, only about in the year afterwards. Another study of outpatient mental health facilities in 20 states found that didn鈥檛 offer MOUD.
鈥淗ealthcare systems would be a place where it should be straightforward to get those medications,鈥� says at the National Institute on Drug Abuse in Maryland. 鈥淲hat is making it difficult for clinicians to provide these medications, then?鈥�
She and her colleagues analysed data from more than 66,000 doctors and found that the is essentially bureaucratic red tape.
There are several barriers to prescribing MOUD. For example, only designated opioid treatment programmes, of which there are roughly in the US, can administer methadone. People often must visit these clinics on a daily or weekly basis, wait in long lines, and undergo routine drug screenings to receive the medication as well, says at Temple University in Pennsylvania. 鈥淚t鈥檚 almost a full-time job to be a patient on methadone,鈥� he says.
In February, the (SAMSHA) eased some of these restrictions, allowing programmes to dispense a take-home supply of methadone that can last a week to a month. It also removed the mandate requiring that people have an opioid use disorder diagnosis for at least one year before getting methadone.
However, people still can鈥檛 get methadone unless they can access a designated programme, which is challenging for those who live in rural areas or are homeless, says Stern.
Inadequate training was another reason doctors felt reluctant to prescribe MOUD. But this has more to do with stigma than actual skill or knowledge. 鈥淲e overcomplicate [substance use] treatment,鈥� says Stern. For example, until last year, doctors had to obtain a special waiver to prescribe buprenorphine and could only prescribe it to 30 people at a time. 鈥淎s a result of that, physicians think it must be so difficult,鈥� says Volkow, adding that many may be under the impression they need special training to prescribe the drugs. Yet that isn鈥檛 the case. 鈥淧roviding insulin for diabetes treatment is complicated, but we learn how to do it,鈥� says Stern. 鈥淧roviding evidence-based medication for opioid use disorder should be no different.鈥�
To overcome this belief among doctors, SAMSHA has developed a for MOUD. It has also created a substance use disorder curriculum that medical schools can use. Additionally, the government mandated last year that any medical worker applying for or renewing their license to prescribe controlled substances must .
鈥淲e are in the throes of an out-of-control public health crisis and the people who are at highest risk of overdose and highest risk of death are the people who are potentially least likely to gain access to care,鈥� says Stern. 鈥淲e have an obligation to minimise those barriers to care.鈥�
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