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Staring down the opioid epidemic.

Nearly 80 people die every day in America from an opioid overdose. (1) At the same time, sales of prescription painkillers have increased 4-fold since 1999. (2) My own medical assistant was given an unsolicited prescription for 40 oxycodone after a wisdom tooth extraction.

Meanwhile, about 80% of the country's 2 million opioid-dependent patients are not receiving the treatment they need. (3,4) In Vermont, for example, more than 500 patients are on waiting lists to receive buprenorphine (the partial opioid agonist used to treat opioid addiction)--a wait that for many of them will last for more than a year and may cost them their life. (5)

* Buprenorphine makes good sense. Fortunately, buprenorphine can reverse opioid cravings within minutes. Medication-assisted treatment with buprenorphine derivatives allows patients to lead normal, productive, and stable lives. Every dollar invested in treating opioid addiction saves society $7 in drug-related crime and criminal justice costs. (6) In addition, 50% to 80% of opioid-dependent patients remain opioid-free for 12 months while taking buprenorphine. (7)

* Steps we can take. As family physicians (FPs), we are frequently overwhelmed by regulatory concerns, overhead expenses, and providing meaningful use data to third-party payers. And we sometimes take the easy route of simply prescribing or refilling scheduled drugs. Instead, we should educate ourselves and our patients about alternative therapeutic interventions for pain control and addiction.

To that end, I encourage all FPs to take the 8-hour online course provided by the American Society of Addiction Medicine to obtain a US Drug Enforcement Administration waiver for prescribing buprenorphine (available at: It costs less than $200 and successful completion of this CME program allows FPs to deliver office-based opioid dependency interventions as per the Drug Addiction Treatment Act of 2000.

Right now, monthly patient censuses indicate that there are about 3234 buprenorphine prescribers providing care for 245,016 opioid-dependent patients, and fewer than 20% of those prescribers are FPs. (8) We need to change that. We have an opportunity to invest in the future of these high-risk patients. Let's not let them down.

(1.) Democratic staff of the senate committee on finance. Dying waiting for treatment: the opioid use disorder treatment gap and the need for funding. October 10, 2016. Available at: Treatment%20Gap%20Report%20Final.pdf. Accessed December 14, 2016.

(2.) Centers for Disease Control and Prevention. Vital signs: overdoses of prescription opioid pain relievers--United States, 1999-2008. MMWR Morb Mortal Wkly Rep. 2011;60:1487-1492.

(3.) Saloner B, Karthikeyan S. Changes in substance abuse treatment use among individuals with opioid use disorders in the United States. JAMA. 2015;314:1515-1517.

(4.) Substance Abuse and Mental Health Services Administration. Opioids. Available at: Accessed December 14, 2016.

(5.) Vestal C. Waiting lists grow for medicine to fight opioid addiction. Stateline. February 11, 2016. Available at: analysis/blogs/stateline/2016/02/11/waiting-lists-grow-for-medicine-to-fight- opioidaddiction. Accessed December 14, 2016.

(6.) National Institute on Drug Abuse. Principles of drug addiction treatment: a research-based guide (third edition). Is drug addiction treatment worth its cost? Available at: researchbased-guide-third-edition/frequently-asked-questions/drug-addiction- treatment-worth-its-cost. Accessed December 14, 2016.

(7.) Kleber HD. Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues Clin Neurosci. 2007; 9:455-470.

(8.) Stein BD, Sorbero MJ, Dick AW, et al. Physician capacity to treat opioid use disorder with buprenorphine-assisted treatment. JAMA. 2016;316:1211-1212.

Jeffrey R. Unger, MD, ABFP, FACE Unger Primary Care Concierge Medical Group, Rancho Cucamonga, Calif. Dr. Unger is a member of JFPs editorial board. He reported no potential conflict of interest relevant to this article.
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Author:Unger, Jeffrey R.
Publication:Journal of Family Practice
Article Type:Guest commentary
Geographic Code:1USA
Date:Jan 1, 2017
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