Tag: buprenorphine

The opioid epidemic has touched all races, but when it comes to seeking treatment, some minority groups are at a distinct disadvantage, a panel of experts said at a recent online forum.

Addicts who want to kick their habit in predominantly white communities have more access to take-home treatments while those who live in heavily minority communities usually must rely on clinics, making it harder to recover.

Studies show that white people usually can more readily access medications like buprenorphine, a take-home treatment plan, while racial minorities are left to seek treatment in methadone clinics.

Both drugs aid addicts in trying to reduce their dependence on opioids like heroin or synthetics like fentanyl.

“Access to these two medications is really racially segregated so that neighborhoods with a higher proportion of Black and Hispanic residents have more access to methadone but lower access to buprenorphine whereas neighborhoods with a higher proportion of white residents have more access to buprenorphine,” said Magdalena Cerdá, professor in the division of epidemiology at NYU Grossman School of Medicine’s Department of Population Health. “There’s real racial inequity.”

She spoke as part of a Jan. 31 panel sponsored by the Center for Health Journalism at the University of Southern California.

With “buprenorphine, you can get a prescription from your doctor, and you can consume it at your home at your leisure,” Cerdá said. With “methadone, you have to go into the clinic, especially at the beginning, often every day and it is a highly punitive setting where you consume these medications.”

With synthetic opioids like fentanyl-laced drugs flooding illegal markets, authorities are focusing on what they call “harm reduction,” which involves putting an emphasis on access to medication and treatment to prevent fatal overdoses and cure addiction. That’s why issues of access to methadone and buprenorphine become so important.

 

Danielle Russell, an Arizona State University doctoral student in justice studies, participated with University of Arizona researchers and others in looking at whether Arizonans had access to methadone and buprenorphine during the Covid pandemic. They discovered that not a single participant in the study received the federally allowed 14- or 28-day methadone take-home doses. All participants felt that daily clinic visits disturbed their day, exposed them to the virus and they considered them unfair to require during a pandemic, according to the study published last October.

A study published in the medical journal JAMA Psychiatry in 2019 found that buprenorphine treatment is “concentrated among white persons and those with private insurance or use self-pay.” Another study, one done in 2017 by Case Western Reserve University and two university hospitals, showed that more than half the physicians in Ohio who prescribe buprenorphine only accepted cash, creating an additional barrier in low-income communities.

The NYU Grossman School of Medicine studied community access to preventive medicine. It found 87% of people with opioid-use disorder do not receive medication. The study proved that states that have expanded their Medicaid policies have not only experienced an increase in access to treatment but have seen a decline in heroin and synthetic opioid overdoses.

Arizona had 3,246 non-fatal opioid overdoses last year and 1,631 deaths, the Arizona Department of Health Services reports.

During the Covid pandemic, overdoses rose. In 2020, 68,630 died from opioid overdoses in the United States, according to the National Institute on Drug Abuse.

Scott Higham, a Washington Post reporter who has covered the opioid epidemic and written a book about it, said fentanyl now dominates synthetic opioid production.

“Fentanyl is the most profitable drug in the black market,” Higham said during the USC forum. “Fentanyl can be very cheap. You can make it in your bathtub at home.”

 

Arizona Health Care Cost Containment System Director Jami Snyder approved new treatment options for opioid patients using Medicaid Thursday, after the Pharmacy and Therapeutics Committee recommended the changes last month.

The changes, which were urged by a group of doctors and will go into effect October 1, add a generic buprenorphine sublingual tablet and a buprenorphine injectable that requires prior authorization to the preferred drug list, according to AHCCCS spokeswoman Heidi Capriotti. The drugs help to prevent withdrawal symptoms.

Prior to the change, there was only one buprenorphine product on the AHCCCS preferred drug list, Suboxone. AHCCCS is Arizona’s Medicaid program, which serves roughly 1.8 million people throughout the state.

Buprenorphine is a medication-assisted treatment option for people who are addicted to opioids, and there are many buprenorphine medications currently on the market. Buprenorphine is one of the main medications used to treat opioid dependence.

Arizona Public Health Association Director Will Humble said he was optimistic about the changes.

“Having additional options is going to be good for physicians and patients,” Humble said.

Humble said having multiple options can also help with delivery methods, even if the strength and formula are the same. For example, he said if a patient was using the film delivery method and relapsed, taking a tablet may work better for that individual

“Even though strength and formulation might be similar, a different delivery method might be beneficial,” he said.

The decision came after the Pharmacy and Therapeutics Committee recommended the changes May 24.

Before the committee meeting, a group of 22 Arizona physicians signed a petition and sent it to the committee calling for more treatment options.

“While the medical impact of delays and disruptions on patient treatment is a concern for all medical conditions, with opioid dependence, especially with the Medicaid population, the impact is often life threatening,” the petition said. “A delay of even 24 hours to medications for our patients could result in compromising the patient’s health and impact family relations, employment, and result in possible criminal justice consequences.”

The petition said the current amount of medication is “falling far short of meeting the myriad needs of our patients, many of whom are the most vulnerable in our society.”

“We are asking you to make the state of Arizona a national leader in addressing this epidemic in a comprehensive manner that is driven by the physician and is in the best interest of the patient,” the physicians wrote.

Although there was only one buprenorphine option on the preferred drug list, there are other treatment options already on the list, including the commonly used medicine methadone.

My name is Jaclyn Brown, and I’m writing this letter because my brother Marc can’t.

It was 2010, and he was a 21-year-old junior studying business at the University of Arizona. That’s when Marc was involved in a serious car accident that broke his pelvis. Doctors prescribed Oxycodone for the pain.

This was a different time. People didn’t understand the danger in taking these drugs for an extended period, and prescription guidelines were nothing like today. My brother’s use of Oxycodone soon became an addiction.

Marc’s experience isn’t uncommon. After his access to prescription opioids became too difficult, he transitioned to the street equivalent: heroin. My parents and I did everything we could, and Marc fought to recover. He was on AHCCCS and attempted rehabilitation twice, but was limited both in the length of rehab stay that AHCCCS would cover and the treatment medication it provided.

Opioid dependency is difficult to beat. That’s why most addiction medicine specialists favor a combination of drug counseling together with a buprenorphine medication that helps dull cravings. If you’re an Arizonan with private insurance, chances are good that you and your physician have access to a menu of buprenorphine options that have come on the market to treat opioid addiction.

But if you’re an AHCCCS enrollee, like my brother, there’s just a single buprenorphine product: Suboxone. Marc and other patients who don’t succeed with Suboxone have no easy access to an alternative for a second chance.

By 2018, Marc had been battling substance use disorder for the better part of a decade. But he was trying to get his life together, living with our parents in Sierra Vista and working to finish his degree at UA-South.

My brother died of a heroin overdose on Nov. 16, 2018. He was 29.

I want to be clear that I don’t blame AHCCCS for Marc’s death. He was an adult and made his own choices. But I’ve spent the last six months wondering whether my brother could have been saved, whether a different buprenorphine treatment could have made the difference for him.

It’s too late for my brother, but there’s still time for countless other AHCCCS enrollees struggling with opioid addiction. They deserve the best possible chance of recovery. And their physicians are owed the broadest possible arsenal of medications to fight this battle.

Thankfully, on May 23, the Pharmacy & Therapeutics Committee has an opportunity to right this wrong. It can recommend that AHCCCS make available all or at least a wider range of FDA-approved buprenorphine products for the purpose of treating opioid addiction.

I urge the committee and AHCCCS to take this important step. You never know whose life it may save.

Jaclyn Brown is a member of an Arizona family that has experienced the trauma of opioid addiction. She lives in Mesa.