NOVEMBER 2021

The opioid epidemic has emerged as a national concern as overdose-related deaths have reached record numbers, with over 70% of deaths in 2019 involving prescription opioids, heroin, or synthetic opioids (fentanyl). According to the CDC, 91 Americans die from opioid overdose everyday [1]. 

A New York Times article published in 2013, “Addiction Treatment with a Dark Side,” details the harrowing reality of the opioid crisis, and how drug companies played a major role in the first wave of the epidemic by prioritizing profits over people [2]. Nearly a decade later, the crisis persists despite key initiatives being introduced to prevent substance abuse in communities across the country.  

Prescription opioids, such as buprenorphine and methadone, are used to manage and relieve both acute and chronic pain as well as opioid use disorder (OUD). Buprenorphine, approved by the FDA in 2002, was widely considered to be a novel pharmacotherapy in treating opioid addiction and was prescribed and dispensed by doctors at high rates. Increased prescription of buprenorphine and other opioid medications led to illicit use and diversion [3]. 

Buprenorphine (Subutex) works by binding to opioid mu-receptors in the brain with strong affinity, such that it displaces other opioids via competitive binding. As a partial opioid agonist, it has a lower efficacy at the opioid receptor upon binding due to the ceiling effect that occurs, limiting the respiratory depression and euphoric effects. Therefore, it is a safer option than methadone as it decreases the potential for abuse and overdose. Additionally, the combination of naloxone (Suboxone) further deters potential abuse of buprenorphine by removing opiates at the receptors and causing uncomfortable withdrawal symptoms if not taken as directed [2][3].

Although the introduction of buprenorphine and naloxone was an attempt to discourage misuse, the opioid epidemic was already well underway due to the large patient base that had already been prescribed buprenorphine and other prescription opioids. Many of the marketing tactics employed by pharmaceutical companies were misleading and disingenuous, as prescribing doctors had limited training in addiction and did not monitor their patients, and many saw this as a money-making scheme. The culmination of all these factors helped fuel the crisis to where it is today [2].         

As we look to curb this deadly epidemic, the healthcare industry at large must confront their role in contributing to this public health crisis and echo a response that addresses the growing number of deaths and hospitalizations. In regards to prescribing practices, it is our responsibility as healthcare personnel to carefully weigh the risks and benefits before offering prescription opioids to patients as part of their treatment. Active efforts should be made to offer comprehensive education to HCPs and PCPs alike, so they are able to then properly educate their patients. From industry to hospitals to clinics to pharmacies, healthcare professionals must come up with innovative solutions to combat this devastating epidemic on multiple fronts.

References:

[1] Centers for Disease Control and Prevention. (2021, March 16). Prescription opioid data. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/deaths/prescription/index.html  

[2]  Sontag, D. (2013, November 16). Addiction Treatment With a Dark Side. New York Times. Retrieved from: https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html. 

[3] Ling W. (2012). Buprenorphine implant for opioid addiction. Pain management, 2(4), 345–350. https://doi.org/10.2217/pmt.12.26