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\u201cWe emphasize to providers, patients and the public that opioid use disorder treatment is primary care,\u201d said\u00a0Beth Meyerson, PhD<\/b>, policy director for the Comprehensive Center for Pain & Addiction and a professor and director of the\u00a0Harm Reduction Research Lab<\/b><\/a>\u00a0at the\u00a0U of A College of Medicine \u2013 Tucson<\/b><\/a>\u2019s\u00a0Department of Family and Community Medicine<\/b><\/a>. \u201cWe focus on improving opioid use disorder treatment \u2013 the quality of it and access to it \u2013 to increase wellness and even reduce opioid overdose and deaths.\u201d<\/p>\n \u201cAccess to evidence-based standard-of-care treatment for opioid use disorder will reduce opioid overdose deaths by 60% \u2013 some studies document 80% reduction,\u201d Meyerson added. \u201cThat’s life changing when we think about the fact that one person dies every five minutes from an opioid overdose in the United States.\u201d<\/p>\n The safer opioids<\/b><\/p>\n When a person ingests, smokes or injects an opioid, it binds to opioid receptors located on cells in the brain. The receptors activate cellular pathways that block pain, lower stress and release dopamine, thereby boosting feelings of pleasure. This physiological response is what makes opioids effective for treating pain, but also highly addictive.<\/p>\n Methadone is a full agonist, meaning it activates 100% of the opioid receptor. It is approved for pain management and to treat opioid use disorder. As a MOUD, it is highly effective at relieving withdrawals and preventing cravings and has lower abuse and overdose potential than opioids such as oxycodone, codeine, hydrocodone or heroin. When used to treat people with opioid use disorder, methadone can only be dispensed through an Opioid Treatment Program certified by the Substance Abuse and Mental Health Services Administration.<\/p>\n Naloxone and naltrexone are antagonists, which mean they completely block the opioid receptors without activating them. Naloxone is a fast-acting medication that rapidly reverses an opioid overdose. \u00a0Naltrexone is long acting and used to help prevent relapses into alcohol or opioid abuse.<\/p>\n Buprenorphine is a partial agonist, so it only activates some of the opioid receptors. Similar to methadone, when used to treat opioid use disorder it is highly effective at relieving withdrawal symptoms and decreasing cravings. It also is highly effective at treating moderate to severe acute pain and is safer than opioids with a lower potential for abuse or overdose.<\/p>\n MOUD: a checkered past<\/b><\/p>\n \u201cWe have a culture of pain \u2013 we do not like pain, we are not accustomed to pain. We are told that pain is bad, avoid it at all costs, and we are dealing with the byproduct of that thought process,\u201d\u00a0Maria Manriquez, MD<\/b>, said, referring to the ongoing national opioid epidemic. \u201cWhy has it taken until 2024 to finally focus on the treatment of pain and addiction?\u201d<\/p>\n Manriquez is the Comprehensive Center for Pain & Addiction\u2019s Phoenix branch director and an\u00a0obstetrician-gynecologist<\/b><\/a>, addiction medicine specialist and\u00a0professor\u00a0at the\u00a0U of A College of Medicine \u2013 Phoenix<\/b><\/a>. Her clinical practice at Banner \u2013 University Medical Center Phoenix focuses on substance use disorders in pregnant and parenting people and increasing access to care. She believes the current state of addiction medicine was influenced by a pivotal law that was enacted more than a century ago: the Harrison Narcotics Act of 1914.<\/p>\n \u201cThe Harrison Act was not a prohibition act, but it basically said that we physicians should not treat patients with addiction with opioids,\u201d Manriquez said. \u201cUltimately, it became significantly taboo \u2013 so off-limits that doctors weren\u2019t well trained. There are a lot of providers out there who were never taught how to identify a use disorder or how to manage it.\u201d<\/p>\n Management options for opioid use disorder remained limited until the middle of the 20th century. Methadone, first approved as a long-acting analgesic in 1947, underwent testing to examine its potential as an opioid use disorder treatment in the early 1960s. It was approved in 1972 and has been strictly regulated since, resulting in access issues for patients who cannot travel to an Opioid Treatment Program every day to receive the single dose they are allotted.<\/p>\n Buprenorphine was discovered and synthesized in 1966. In the UK, an injectable form was approved as an analgesic in 1977, followed by a tablet form in 1980. By 1985, buprenorphine was available worldwide as a pain-relieving medication.<\/p>\n Through the 1970s and \u201980s, scientists diligently studied buprenorphine\u2019s potential as a treatment for opioid use disorder. In 1990, the National Institute on Drug Abuse reviewed a preliminary paper, eventually\u00a0published in JAMA<\/b><\/a>, which found that opioid-dependent, heroin-using participants used significantly less opioids when taking buprenorphine and had better retention than participants who were taking methadone.<\/p>\n Two buprenorphine products, Subutex\u00ae, containing only buprenorphine; and Suboxone\u00ae, a buprenorphine\/naloxone combination, received FDA approval in 2002.<\/p>\n Moving forward, modernizing laws<\/b><\/p>\n Buprenorphine was meant to increase access to care for opioid use disorder by allowing some physicians in office-based settings to prescribe the medication. After completing eight hours of training, physicians were given a waiver to prescribe buprenorphine to no more than 30 patients the first year. \u00a0The second year, they could treat 100 patients.<\/p>\n Fifteen years later, a comprehensive opioid bill signed into law in 2018 allowed for nurses to become waivered practitioners; and waivered physicians could prescribe MOUD for up to 275 patients. In 2021, the Department of Health and Human Services\u00a0changed practice guidelines<\/b><\/a>\u00a0to allow any provider to prescribe buprenorphine for up to 30 patients without a waiver.<\/p>\n The changes were intended to increase access to care, but did they?<\/p>\n In 2022, Meyerson led a \u201csecret shopper\u201d study that assessed the accuracy of government-maintained lists of Arizona providers prescribing MOUD and the extent to which these providers are accessible for treatment. The study, published in the\u00a0Journal of Substance Use and Addiction Treatment<\/b><\/a>, attempted to contact more than 2,300 providers who were listed by the Drug Enforcement Agency and the Substance Abuse and Mental Health Service Administration as prescribing methadone or buprenorphine.<\/p>\n \u201cOur secret shopper study demonstrated that only 36% of the government-listed providers were actually providing MOUD,\u201d Meyerson said.<\/p>\n The study also found that 91.2% of Arizona doctors who could prescribe buprenorphine were in urban areas, resulting in a lack of access to care and health disparities for people in rural Arizona communities.<\/p>\n \u201cOf those, 26% were not accepting new patients,\u201d Meyerson added.<\/p>\n Last year, the\u00a0Consolidated Appropriations Act<\/b><\/a>, also known as the Omnibus Bill, completely removed the waiver requirement for practitioners to prescribe medications, including buprenorphine, for the treatment of opioid use disorder.<\/p>\n That change, along with educational efforts aimed at training future providers, give Meyerson and Manriquez hope for the future.<\/p>\n \u201cToday, we are lucky in that we have\u00a0pain<\/b><\/a>\u00a0and\u00a0addiction medicine<\/b><\/a> fellowships,\u201d Manriquez said of the resident-training programs that are available at the Colleges of Medicine in Tucson and Phoenix, respectively. \u201cWe are helping residents learn to identify opioid use disorder, and then giving them the tools and hope for the future on how to manage pain and addiction.\u201d<\/p>\n \u201cI, along with other faculty, make sure future and new physicians are ready to practice the full range of primary care, which includes providing treatment for opioid use disorder,\u201d Meyerson added. \u201cOurs is just one discipline piping into primary care, so we are studying the likelihood that future primary care providers from all incoming disciplines will manage their patients on buprenorphine and eventually methadone.\u201d<\/p>\n Still, there is much work to be done to assure that treatment for opioid use disorder is equitable and accessible for all.<\/p>\n \u201cBuprenorphine is very easy to get on the street, and the reasons people buy buprenorphine illicitly, I think, are because, one, withdrawal sucks, and two, there aren’t enough providers to treat patients,\u201d Manriquez said. \u201cWe need to work with our legislators to amend laws and regulations, increase funding for pain and addiction research, and expand access to treatment options. We are the voice of our patients.\u201d<\/p>\n","protected":false},"featured_media":2105,"parent":0,"template":"","college":[],"uahs_theme":[13],"class_list":["post-1984","story","type-story","status-publish","has-post-thumbnail","hentry","uahs_theme-precision-health-care-for-all"],"acf":[],"yoast_head":"\n![\"\"](\"https:\/\/annualreports.healthsciences.arizona.edu\/2024\/wp-content\/uploads\/2024\/12\/2-M-Manriquez015-819x1024.jpg\")
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