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Myths and Realities of Opioid Use…

 

Myths

  1. Buprenorphine treatment is more dangerous than other chronic disease treatment.
  2. Buprenorphine is a replacement addiction.
  3. Detoxification for opioid use disorder is effective.
  4. Prescribing buprenorphine is time-consuming and burdensome.
  5. Reducing opioid prescribing alone will alone reduce overdose deaths.

Realities

  1. Buprenorphine treatment is simpler than many other routine treatments in primary care, for example, insulin titration and starting anticoagulation.
  2. Addiction is defined as compulsively using a drug despite harm. Taking a prescribed medication to manage a chronic illness does not meet that criterion.
  3. There is no data showing that detoxification programs are an effective treatment for opioid use disorder. These interventions may increase overdose deaths by eliminating tolerance.
  4. In office inductions and intensive behavior therapy are not required for effective treatment.
  5. Despite decreasing opioid prescribing overdose mortality has increased. The noticeable shift to the illicit drug market, where the risk of overdose is higher.

Possible Policy Response

  1. Amend federal Buprenorphine treatment eligibility requirements during medical school or residency training.
  2. Competency questions in U.S Medical Licensing Examination.
  3. A public health campaign to reduce the stigma associated with addiction treatment. An example is the previous HIV campaigns.
  4. Educate federal and state agencies and policymakers about evidence-based treatment and the lack of short-term detoxification and treatment.Develop disseminate protocols for primary care settings that emphasize out of office induction and treatment.
  5. Develop a national system of virtual consultation for physicians to reach addiction and pain specialists who can support the treatment of suspected opioid use disorder.

Wakeman, S. E., & Barnett, M. L. (2018). Primary Care and the Opioid-Overdose Crisis — Buprenorphine Myths and Realities. New England Journal of Medicine, 379(1), 1-4. doi:10.1056/nejmp1802741

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