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July 8, 2019

Offering Emergency Buprenorphine Without a Prescription

Author Affiliations
  • 1Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
  • 2Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
JAMA. 2019;322(6):501-502. doi:10.1001/jama.2019.8309

It is estimated that 2 million individuals in the United States have opioid use disorder (OUD) and an estimated 130 deaths from opioid overdose occur each day.1 However, it is estimated that only 20% to 40% of individuals with OUD receive medications such as buprenorphine, methadone, and naltrexone to treat this disorder.2

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    3 Comments for this article
    Buprenorphine Can and Should be Started by a PCP or ED Physician and Supervised at MAT clinics
    Boris Golosarsky, MD | ROAD To A Better Life, MAT
    This is a good and long awaited article. I disagreed with “a behind the counter“ dispensing model for buprenorphine. Patients in general do not die from opioid withdrawal but from poorly managed medication-assisted withdrawal (MAT). MAT cannot be properly administered without knowledge of patients' individual unique illicit exposures. Chronic disease model management should be the standard of care for substance use disorders. PCP and ED staff can and should initiate induction treatment and refer patients to a decent MAT clinic
    CONFLICT OF INTEREST: https://roadtoabetterlifenh.com/ Addiction Medicine Board certified
    An Idea Whose Time Has Come
    Francis Holt, PhD, RN |
    Just as we now see AED's in many public spaces now because they save lives, more widely and immediately available buprenorphine should become the norm because of its live-saving potential. "Out-of-pocket costs may remain a barrier to access, but could serve as another incentive for patients to seek prescriptions, which would be more likely to be covered by insurers" is a true enough statement. But many opiate users fall into the category of "eligible but not enrolled" for health insurance. Sort of like being disenfranchised by virtue of your disease. Because of this reality on the ground, I believe buprenorphine's cost should be absorbed by government as a public-health expense.
    Buprenorphine Needs to be Prescribed by Physicians
    Kevin Miller, MD | Paradise Family Healthcare, Venice, Florida
    After many years of treating opioid use disorder with buprenorphine I have seen many cases where patients have decided they needed to start MAT with buprenorphine when they did not really need it. Examples abound -- the 45 year old woman who experiences withdrawal after stopping Vicodin after two years of use, then consults Dr. Google and decides she's addicted and needs buprenorphine when she really just needs help to taper off; the man that becomes dependent when he starts taking his wife's Oxycontin 80 when she dies in hospice - who doesn't need Suboxone, but rather help tapering off and grief counseling. To justify the use of MAT with Suboxone there should be a high risk of relapse, compulsive or impulsive use that raise the risk of overdose and failed attempts to quit with or without medical guidance.