More doctors can prescribe a leading addiction treatment. Why aren’t more people getting help?

Editors’ notes

It’s easier than ever for doctors to prescribe a key medicine for opioid addiction since the U.S. government lifted an obstacle last year. But despite the looser restrictions and the ongoing overdose crisis, a new study finds little change in the number of people taking the medication.

Researchers analyzed prescriptions filled by U.S. pharmacies for the treatment drug buprenorphine. The number of prescribers rose last year after doctors no longer needed to get a special waiver to prescribe the drug, while the number of patients filling prescriptions barely budged.

It may take more than one year to see a bigger increase in patients, said study co-author Dr. Kao-Ping Chua of the University of Michigan Medical School.

“There are so many other barriers to prescribing that we have to address,” said Chua.

The findings were published Wednesday in the New England Journal of Medicine.

Buprenorphine, which helps with cravings, comes in a pill or film that dissolves under the tongue. It costs about $100 a month. A common version of buprenorphine is Suboxone. Nurse practitioners, physician assistants and doctors can prescribe it.

“People think this is a very complicated medicine and that it requires some sort of complex knowledge to use, when that’s just not the case,” said Dr. Ryan Marino of Case Western Reserve University School of Medicine in Cleveland who has treated hundreds of people with buprenorphine. He had no role in the study.

Barriers include insurance hurdles, price, pharmacies that don’t stock the drug and doctors who believe patients with addiction take up too much time, Chua and other experts said.

“There’s a lot of stigma about this medication, and just in general about patients with opioid addiction,” Chua said.

In addition, some people may not want to try buprenorphine, Chua said. They may think they can’t truly recover if they’re using the opioid-based medication, he said. And it can trigger withdrawal symptoms, especially in people who’ve been using fentanyl, the powerful opioid now dominating the drug supply.

The researchers used a database that captures 92% of filled prescriptions. Comparing 2022 and 2023, before and after the waiver was eliminated, they found 53,600 prescribers at the end of 2023, a 27% increase compared to a year earlier. The number of people filling prescriptions rose about 2% to around 845,000.

The government should look for ways to encourage and even compel hospitals and health systems to provide more treatment, said Brendan Saloner, an addiction researcher at Johns Hopkins Bloomberg School of Public Health, who was not involved in the study.

More doctors are prescribing buprenorphine, but “getting the bulk of the medical profession to catch up is taking too long,” Saloner said.

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