Brian J. Piper, PhD, MS Department of Basic Sciences Geisinger Commonwealth School of Medicine Scranton, PA 18509

Medical, and Non-Medical, Buprenorphine Use Increases

MedicalResearch.com Interview with:

Brian J. Piper, PhD, MS Department of Basic Sciences Geisinger Commonwealth School of Medicine Scranton, PA 18509

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/

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

Aug 9, 2019 @ 11:31 am

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