Buprenorphine: not the best solution to treat opiate addiction

In the United States, opiate addiction is a serious public health problem. In a new study, researchers from the College of Physicians and Surgeons at Columbia University (USA) have found that people with opioid addiction are at risk of an overdose after 18 months of treatment with buprenorphine, a drug that terminates the treatment. According to the researchers, 5% of people who took this drug for 6 to 18 months needed medical attention for an opioid overdose within six months of stopping buprenorphine treatment. However, this figure could be higher, as the study does not take into account cases of overdose that are not registered with healthcare facilities. Their work was published on December 2 in the journal The American Journal of Psychiatry.

Study author Arthur Robin Williams, an assistant professor of clinical psychiatry at Columbia University, said stopping buprenorphine could be life-threatening for patients who took it, depending on how quickly they relapse. and overdose after treatment ends. Interestingly, the researchers observed that the risk decreased over time: the longer patients continued treatment, the lower the risk of other types of adverse effects, suggesting that treatment with buprenorphine might be more effective as a long-term treatment.

To remain prisoner of a treatment

As the opioid crisis spirals, attention is focused on the difficulties that an estimated 2.1 million patients face in accessing evidence-based healthcare. Each year, buprenorphine, which obtained approval from the Food and Drugs Administration in 2002, is prescribed to around 1 million people. However, most of these patients (between 50% and 80%) stop treatment after a few weeks or even a few months. Although there is no clear agreement on how long buprenorphine should be taken, most specialists advocate indefinite use.

Another important factor is that a number of insurance policies limit buprenorphine treatment to six months, or require annual reauthorization, so that patients at risk are not trapped in their treatment. According to Arthur Robin Williams, a number of clinicians believe that buprenorphine should be prescribed for a limited period, due to the mistaken belief that people on opioid addiction medication are not truly on the mend. According to him, this study is the first to look at the effects of prolonged use of buprenorphine treatment.

A treatment to be taken indefinitely

By studying claims data from about 9,000 adults aged 18 to 64 who had been on continuous treatment for at least 6 months to 18 months, the researchers found that about one in 20 people were treated for an opioid overdose at least once within six months of finishing treatment.

Additionally, the researchers found that prescriptions for opioids jumped 25%, while emergency room visits increased by 45% within six months of stopping buprenorphine. These numbers were especially true for people with mental illness. Those who stopped treatment after six months reported significantly higher numbers in both categories compared to people in the 15- to 18-month cohort.

The study highlights the results of previous studies, which showed that the risk of death from an opioid overdose is reduced by up to 70% during treatment with buprenorphine. Most patients relapse after stopping the drug. Buprenorphine treatment is required for many years, if not indefinitely, to reduce the risk of overdose and other adverse events.