08 Aug Medical, and Non-Medical, Buprenorphine Use Increases

MedicalResearch.com Interview with:

Dr. Piper

Brian J Piper, PhD MS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, Pennsylvania 

MedicalResearch.com: What is the background for this study?

Response: All states have a Prescription Monitoring Program to collect data about controlled substance prescriptions. Maine also had a Diversion Alert Program to obtain information about arrests involving prescription and illicit drugs.

Buprenorphine is a treatment for an opioid use disorder. Naloxone is an opioid antagonist. Prior pharmacoepidemiology research found that buprenorphine accounted for half of prescriptions for males in their twenties in Maine.¹

This study examined the current status of the opioid crisis using three complementary data sources:

1) Arrests as reported to the Diversion Alert Program;
2) Medical opioid use as reported by the Drug Enforcement Administration; and
3) Overdoses as reported to the medical examiner.

MedicalResearch.com: What are the main findings? 

Response: There were three main findings.

• Medical use of buprenorphine showed a pronounced increase (+58.1%) between 2012 and 2017. In contrast, many other opioids that are used for pain showed appreciable decreases (oxycodone: -46.9%, fentanyl: -49.4%, hydrocodone: -56.0%).
• Among the 719 arrests in 2017 involving opioids, heroin was responsible for almost half (48.8%). We were surprised to discover that the second most common opioid was buprenorphine which was involved in more arrests (147) than oxycodone, hydrocodone, methadone, tramadol, and morphine, combined.
• Third, opioids were involved in the vast majority (84.7%) of overdoses in 2017. The opioid antagonist naloxone was identified in almost one-third (30.9%) of drug involved deaths. It was not possible to differentiate in this dataset whether naloxone was present as a result of being employed as an acute overdose reversal drug (Narcan) or as part of a long-term pharmacotherapy for opioid dependence (buprenorphine with naloxone or Suboxone). 

MedicalResearch.com: What should readers take away from your report?

Response: Buprenorphine is an evidence based treatment for an opioid use disorder. However, the street value of buprenorphine, on a mg basis, is four fold-higher than morphine.² Of the top five most prescribed drugs based on Maine insurance claims, more money in 2017 was spent on the buprenorphine and naloxone film ($16.8 million) than on the other four agents (hydrochlorthiazide, ProAir, Ventolin, and omeprazole), combined ($12.7 million).³ Together with prior research, this report indicates that continued balance between treatment needs and vigilance to minimize nonmedical use is warranted.

MedicalResearch.com: Is there anything else you would like to add?

Response: There continues to be information silos that impede communication between the law enforcement and health care communities. Maine’s Diversion Alert Program was a mechanism to foster more interactions among these parties and provide otherwise unavailable information to improve health care decision making.

The Drug Enforcement Administration makes controlled substance information at a regional level freely available for opioids, stimulants, and other drug classes.⁴ We continue to be surprised that other public health researchers or data journalists do not make use of this comprehensive resource.

This research was supported by the Fahs-Beck Fund for Research and Experimentation, a non-profit organization, and the Health Resources and Services Administration.

Citation:

Simpson KJ, Moran MT, Foster ML, et al. Descriptive, observational study of pharmaceutical and nonpharmaceutical arrests, use and overdoses in Maine.
BMJ Open 2019;0:e027117. doi:10.1136/bmjopen-2018-027117

References

1. Piper BJ, Desrosiers CE, Lipovsky JW, Rodney MA, Baker RP, McCall KL, Nichols SD, Martin SL. Use and misuse of opioids in Maine: Results from pharmacists, the Prescription Monitoring, and the Diversion Alert Programs. J Stud Alcohol Drugs 2016; 77: 556-565.
2. Dasgupta N, Freifeld C, Brownstein JS, Menone CM, Surratt HL, Poppish L, Green JL, Lavonas EJ, Dart RC. Crowdsourcing black market prices for prescription opioids. J Med Internet Res 2013;15:e178.
3. Lawlor J. Medication for opioid use disorder Maine’s 2nd-most-prescribed drug. December 20,

2018, Accessed 2/17/2019 at: https://www.pressherald.com/2018/12/20/medication-for-opioid-treatment-second-most353prescribed-drug-in-maine/

4. https://www.deadiversion.usdoj.gov/arcos/retail_drug_summary/index.html

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Last Updated on August 9, 2019 by Marie Benz MD FAAD