Letter: Analgesic alternative to treat opioid addiction

Regarding the article “State urges feds to deregulate addiction meds,” April 9, buprenorphine could mitigate the nation’s opioid crisis; however, use is not limited to opioid addiction.

Buprenorphine is a potent analgesic that should be first-line therapy for chronic pain patients requiring long-term opioid therapy, prior to consideration of traditional drugs like oxycodone, fentanyl, morphine, hydrocodone and others. Dissimilar to federal regulation and waivers restricting buprenorphine for opioid addiction, branded drugs such as Belbuca and Butrans may be prescribed by anyone with a U.S. Drug Enforcement Administration license.

Limited buprenorphine access for pain patients is due to poor education among prescribers and, third-party payer formulary limitations that require and favor more dangerous, less-expensive generic opioids.

Because most of buprenorphine’s activity is at the spinal level rather than the brain (unlike traditional opioids), there is a plateau of respiratory depression and reduced prevalence of death.

Analogous to vaccines and naloxone (Narcan) in New York state, pharmacists should be empowered to prescribe buprenorphine for opioid use disorder. The article aptly points out that “… physicians must complete eight hours of training and nurse practitioners and physician assistants must complete 24 hours.” Notwithstanding, several states other than New York allow pharmacists to prescribe birth control products because access is the largest barrier to unplanned pregnancies.

I’d say buprenorphine access to prevent opioid deaths probably trumps birth control to prevent pregnancy, but irrespective, the most accessible professionals are overlooked.

Jeffrey Fudin, PharmD, FCCP, FASHP, FFSMB

Delmar

Adjunct Associate Professor, Albany College of Pharmacy and Health Sciences