By Lisa Rapaport

(Reuters Health) – Despite improved access to opioid addiction treatment in recent years, more than half of the U.S. counties hardest hit by overdoses and deaths don’t have enough clinicians to treat people who need help, a government study suggests.

Nationwide in 2018, almost 47,000 healthcare providers had received waivers from the federal government to prescribe buprenorphine, seen as an alternative to methadone dispensed at federally approved clinics, according to a report from the U.S. Department of Health and Human Services Office of Inspector General.

But 40% of counties nationwide, and 56% of counties with the greatest need for opioid addiction treatment, don’t have a single provider who can prescribe buprenorphine, the report says.

“With an average of 130 opioid-overdose deaths per day, it is vital that patients can access quality, effective treatment in their local communities,” said Ann Maxwell, who oversaw production of the report as assistant inspector general for HHS.

If anything, the report may overestimate how many people have access to buprenorphine, Maxwell said by email. That’s because many providers authorized to prescribe buprenorphine don’t help the maximum number of patients. Waivers typically enable providers to help up to 30, 100 or 275 patients.

Buprenorphine suppresses opioid withdrawal symptoms and relieves cravings. The risk of abuse is lower with buprenorphine because it’s designed to prevent high levels of euphoria that occur with heroin and opioids.

Some communities may lack providers to prescribe buprenorphine because local addiction treatment efforts focus on abstinence instead of medication-assisted treatment, Maxwell said.

“However, abstinence-based treatment – the use of behavioral therapy or counseling combined with complete abstinence – is not scientifically supported,” Maxwell said. “Medication-assisted treatment has been found to be more effective than abstinence-based treatment at keeping patients in treatment and reducing their use of opioids because (these) drugs are designed to reduce opioid cravings and withdrawal.”

The federal government doesn’t track the number of patients receiving buprenorphine, so researchers estimated access based on the number of providers and the number of potential patients who might receive treatment.

A separate study published in JAMA Network Open looked at another aspect of addiction treatment: access to the opioid-overdose antidote naloxone. Opioid overdoses can be deadly because these drugs slow breathing, reducing the body’s oxygen supply. Naloxone blocks the ability of opioids to impact breathing.

In 2015, Ohio became one of a growing number of states allowing pharmacists to dispense naloxone without a prescription. Researchers examined how many people got naloxone at pharmacies there over the year before and the first two years after the law was implemented.

Statewide, just 191 naloxone prescriptions were dispensed the year before the law took effect. Over the next two years, there were 4,637 prescriptions, a 2,328% increase.

The monthly naloxone prescription rate increased by 4% for people insured by Medicaid, the U.S. health program for the poor, and by 3% among people who got prescriptions at the retailer Kroger.

Among people with Medicaid, prescription rates climbed 18% more in communities with the lowest employment levels and the highest poverty levels, the study found.

“This was an important finding because previous research showed that there is a significant correlation between increasing unemployment rates and increases in opioid death rates,” said senior study author Dr. Pamela Heaton of the University of Cincinnati.

“The Ohio policy change showed that patients residing in these vulnerable areas had increased access to naloxone,” Heaton said by email.

Ideally, patients at risk, family and friends, and community members in contact with people at risk should carry naloxone and know how to use it, Heaton advised. The drug, available as an injection or nasal spray, works best when used quickly and can temporarily halt the effects of opioids on breathing.

“While it does act quickly, the effect is temporary and it is very important that emergency personnel are also called,” Heaton said.

SOURCE: https://bit.ly/2SjZyOd U.S. Department of Health and Human Services Office of the Inspector General, online January 29, 2020; https://bit.ly/2GZmugA JAMA Network Open, online January 31, 2020.

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