Around half of all prescriptions for buprenorphine, a drug used to treat opioid addiction, are written by only five percent of physicians, according to a new study.
Researchers from Johns Hopkins University and the RAND Corporation analyzed prescriptions given out by U.S. physicians in 2017 and 2018.
What’s more, primary care physicians were more likely to prescribe the drug rather than pain or addiction specialists.
The team hopes the finding that such a large portion of doctors are responsible for so few prescriptions of the drug will allow them to develop strategies to increase its usage and combat the opioid crisis.
Critics disagree, saying that increasing the usage of buprenorphine, which is an opioid itself, could cause other problems down the line.
Researchers found that a few high volume prescribers are accounting for about half of all prescriptions of buprenorphine. They believe they can increase usage of the drug by focusing efforts on those physicians
For the study, published in the Journal of the American Medical Association, researchers used prescription data from IQVIA, which accounts for around 90 percent of all prescription data in the country, from retail pharmacies for the two years.
They used three metrics to classify physicians: how many months they were actively prescribing the drug, the monthly amount of patients a physician had that they were actively prescribing the drug and the total months of care – which is the total amount of months the drug was prescribed across all patients, combined.
They also separated out the physicians by their type, such as primary care physicians (PCPs), advanced practice practitioners (APPs), pain specialists, psychiatrists, emergency physicians, addiction specialists and others.
PCPs, 43.8 percent of active prescription time, and APPs, 20.6 percent, prescribed the drug the most.
In general, it was found that prescriptions of the drug seemed to be carried by a certain few providers who often prescribe it, called high volume prescribers.
More than half of these high volume prescribers of buprenorphine were PCPs.
Researchers determined that these high volume of prescribers were recommending the drug to an average of around 124 patients each, and that five percent of high volume prescribers them were accounting for 50 percent of total usage of the drug.
HOW AMERICA GOT HOOKED ON OPIOIDS
Prescription opioids and illicit drugs have become incredibly pervasive throughout the US, and things are only getting worse.
In the early 2000s, the FDA and CDC started to notice a steady increase in cases of opioid addiction and overdose. In 2013, they issued guidelines to curb addiction.
However, that same year – now regarded as the year the epidemic took hold – a CDC report revealed an unprecedented surge in rates of opioid addiction.
Overdose deaths are now the leading cause of death among young Americans – killing more in a year than were ever killed annually by HIV, gun violence or car crashes.
About 2,450 doctors were classified as ‘high volume prescriber.’
The researchers believe that maximizing their case load could lead to increased usage of the drug.
The maximum case load for each physician is 275, so only providing the drug to 124 patients each means there is still a lot of room for growth in the prescription of the drug.
‘These findings have important implications for efforts to increase buprenorphine access,’ said Dr Bradley Stein, the study’s lead author, in a statement.
‘Our study suggests that targeted efforts to encourage more current prescribers to become high-volume prescribers, and encourage existing high-volume subscribers to safely and effectively treat even more patients, may be a potent way to increase buprenorphine treatment capacity.’
Some disagree with the assessment from the study, though.
A response published by the Journal of the American Medical Association said that increasing the usage of the drug may not quite be the noble goal the researchers believe it is.
‘Benzodiazepines have limited short-term efficacy, lack efficacy in longer-term use, and have undoubted potential for addiction, physical dependence, and severe long-term harms,’ said the respondent.
‘Like opioids, benzodiazepine use causes tolerance, dependence, and, in some, addiction, and may result in considerable discomfort during withdrawal.’
The response also pointed out that the drug is not to be used long term.
‘We believe the perils of [the drug] were downplayed,’ they said.