New editorial calls for urgent changes to combat the fentanyl crisis in North America

Addiction journal has published an editorial by a group of researchers and clinicians that highlights the need to remove ‘arbitrary limitations’ on buprenorphine treatment for opioid use disorders.

Buprenorphine is one of the main medical treatments for opioid use disorders. It works by partially activating the brain’s opioid receptors – reducing opioid cravings and withdrawal without the ‘high’ that opioids such as heroin or fentanyl produce.

US guidelines for how much buprenorphine to prescribe were created when most opioid problems came from prescription painkillers and heroin, not the stronger drugs that are on the illicit market today. The current opioid crisis is driven by fentanyl and other synthetic opioids, which are highly potent and have changed the challenges and magnified the risks associated with opioid use disorders.

A new editorial in Addiction journal warns that US state and insurance provider policies are limiting patient access to higher doses of buprenorphine, either through arbitrary dose limits or through bureaucratic steps that delay or prevent access to necessary treatment.

Authors Drs Nicole Gastala, Brianna Hudak, Mai T. Pho, Harold Pollack, and Katherine Wilcox from the University of Chicago and University of Illinois at Chicago say that “the reality of the opioid epidemic is that the treatment landscape changes quickly”.

“The fentanyl era has fundamentally reshaped the challenges associated with opioid use disorders. This supply shift necessitates a parallel evolution in treatment paradigms. Outdated buprenorphine dosage restrictions fail to reflect current scientific understanding, and actively impede recovery efforts.”

To ensure buprenorphine prescribing policies can meet the challenge of the current opioid crisis, the editorial recommends:

• Expanding research to assess the safety, efficacy, and optimal implementation of higher-dose buprenorphine, particularly in patient populations exposed to fentanyl
• Updating national and international clinical guidelines to provide a foundation for changing and updating health policies
• Ensuring that health insurance policies align with the latest clinical evidence, and prevent treatment being denied based on outdated guidelines
• Training clinicians in how to prescribe buprenorphine in the ‘fentanyl era’

by Natalie Davies