The article, “Buprenorphine Prescribing and Dosing Limits: Evidence and Policy Goals,” has been published in SAj in Volume 44 Issue 1-2.
In this commentary, the authors state that the opioid misuse epidemic is a serious public health crisis. Opioid-involved deaths continue to rise and the potency of illicitly manufactured synthetic opioids has increased, creating challenges for the healthcare system to provide multifaceted specialized care. Elements of the regulation around buprenorphine, 1 of 3 drugs approved to treat opioid use disorder (OUD), constrain treatment options for patients and providers alike. Updates to this regulatory framework, particularly around dosing and access to care, would enable providers to better treat the changing landscape of opioid misuse. The authors state specific actions to this end are to: (1) Increase buprenorphine dosing flexibility based on FDA labeling which drives payor policies; (2) Restrict local government and institutional impositions of arbitrary access and dosing limits for buprenorphine; and (3) Liberalize buprenorphine initiation and maintenance via telemedicine for OUD.
In the AUTHORS’ OWN WORDS, they relate the importance of their work:
“Reducing barriers to accessing care is a key step that can create lasting change. Among the 2 approved opioid agonist MOUD, buprenorphine is more easily modified from a regulatory perspective. Although advocacy for extended access to methadone has been well articulated and available data show relaxed regulation during the pandemic did not necessarily lead to increased safety concerns, this manuscript focuses on buprenorphine alone. This is because the safety of methadone expansion appears significantly more complex due to its full agonist properties, prolonged half-life, additional physiological effects (eg, QTc prolongation and drug-drug interactions), and regulatory framework. Methadone’s regulatory constraints, justified or not, further support broader use of and easier access to buprenorphine products.”