New Proposed Rules Create Barriers to Buprenorphine
On Jan. 30, 2023, the Biden Administration announced it would end the COVID public health emergency, which could mean new issues regarding telehealth and Medication-Assisted Treatment when the order ends in May this year. MAT, especially buprenorphine, was expanded to online access for most people with opioid use disorder, giving greater access to desperately needed treatment for people in rural areas. Now, it appears that access to buprenorphine may be trickier than it seemed before.
The expansion has saved lives, and there have been repeated assurances by HHS, DEA, SAMHSA, and even the Biden Administration that telehealth buprenorphine patients won’t lose access to treatment. The truth, however, is murkier than it seems. It appears the DEA wants to put much stronger limits to telehealth treatment in place, which could cause unsurmountable access barriers for people who can’t go in person to get their meds prescribed.
What Will the Proposed Rules Do for MAT?
The new proposed rules, treatment advocates say, could cause more harm than good. While they say they’re not stripping access to treatment, the rules would make treatment much more difficult for vulnerable demographics. Patients will be required to have in-person exams and will not be able to continue to a fully virtual telemedicine care regimen. Patients already taking MAT will not be exempted; if their care began at a virtual clinic, they now would need to meet a treatment provider in-person to continue their care.
There seems to be little scientific reasoning behind this; unlike other treatment drugs, buprenorphine is a partial opioid agonist. It is less likely to be abused compared to other opioids due to its unique pharmacological properties and the way it is prescribed. Buprenorphine has a "ceiling effect," which means that after a specific dose, taking more medication does not produce any additional effects, making it less likely to be abused.
Increasing MAT Access Can Only Be a Good Thing
Many medical and professional societies have advocated for increased access to MAT, including buprenorphine. The American Society of Addiction Medicine (ASAM), a professional society representing physicians, clinicians, and other healthcare professionals specializing in addiction medicine, has long argued for increased access to MAT to improve treatment for opioid addiction. The American Medical Association (AMA), the largest professional association of physicians in the United States, has supported efforts to expand access to buprenorphine as part of a comprehensive approach to addressing the opioid epidemic.
Other doctor organizations have recognized the importance of increasing access to buprenorphine to help combat the opioid epidemic and improve the treatment of opioid addiction. The American Academy of Family Physicians, American College of Physicians, and American Osteopathic Association have written letters or papers supporting increasing access to buprenorphine.
Hundreds of organizations signed a paper asking the Biden Administration to make the emergency act telehealth provisions permanent last year; however, the DEA seems to have other thoughts about drug and MAT safety and administration.
Hopefully, the DEA will listen to these organizations and create a rule that’s fair and flexible so that patients can get the treatment they need with the fewest barriers possible.
Getting Help for Addiction
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Medication-Assisted Treatment is considered the gold standard of treatment for opioid use disorder. Experts say the medication, alongside appropriate treatment, and peer support groups is backed by science. MAT can help individuals begin to live substance-free while quelling withdrawal symptoms and cravings. But how well does it work for people who use fentanyl, a drug that is 50 to 100 times the potency of morphine?
Opioid Use Disorder and Fentanyl
Fentanyl is a highly potent drug that is typically used by experienced drug users. Many people who are exposed to drugs in a medical setting end up misusing them. Some people misuse prescription drugs after surgery. Others start out with recreational opioid use, such as OxyContin pills sold online or on the street. Eventually, addiction becomes costly, and people may move up to more potent drugs. Many people who use heroin, Oxycontin and other opioids decide to try fentanyl, a much more potent drug.
Fentanyl addiction is dangerous and deadly. People can quickly become physically addicted, experiencing intense withdrawal symptoms if they cannot use an opioid. Withdrawal is the top reason many people resist getting sober from opioids. People who use fentanyl will have stronger withdrawal symptoms than those using a less potent drug.
Deciding on MAT Dosage For Fentanyl Users
When a person gets sober from opioids and enters a detox program, they are assessed by a clinician for detox symptoms. Yes, MAT can be successful for people addicted to higher-dose opioids. People who have used high doses of drugs such as heroin have still found relief and freedom from cravings using treatment drugs such as methadone, Suboxone or Naltrexone.
A doctor or nurse practitioner will help administer MAT and assess a patient for symptoms after they’ve been sober for 24 hours. There may need to be adjustments to the initial dose. All dosage decisions are made between the healthcare provider and the patient. Some patients will stay on MAT for the duration of their inpatient treatment. Others will stay on it indefinitely. The CDC has said MAT is safe to use for years. For this reason, most sober housing programs treat MAT like they do most medications.
Sober Housing and MAT
People who are sober and meet the requirements of sober housing programs often are on medication. MAT isn’t a big deal; programs are more about focusing on recovery. If you’re interested in sober housing, our program offers community, safety, and recovery in a serene and vibrant environment. Give us a
Many people who decide to get sober use tools like Medication-Assisted Treatment to reduce withdrawal symptoms and help them focus on their recovery. Sublocade is a Medication-Assisted Treatment option many people prefer because it’s only administered once a month. It is prescribed and administered by medical professionals for people with opioid use disorder who want to stay sober.
What Is Sublocade?
Sublocade contains the drug buprenorphine and is administered monthly in a medical provider’s office. For many people, it’s a safe and responsible way to go about their lives while getting relief from withdrawal symptoms and opioid cravings.
Sublocade works best when the person taking it also gets counseling via drug treatment or one-on-one therapy. This can help newly sober people gain insight into themselves and understand their addiction. Opioid use disorder is manageable, but Medication-Assisted treatment is only part of managing it. Getting therapy can also help somebody learn new coping skills and learn to live a more authentic, happy life drug-free.
How Often Is Sublocade Needed?
People prescribed Sublocade need to get the injection monthly in a healthcare provider’s office. Most treatment providers will start patients with a 300mg dosage and eventually will be weaned down to a lower dose, usually 100mg. Some people will stay on 300mg longer if their healthcare provider deems it necessary.
People can use Sublocade as MAT for as long as the doctor approves. Some people will get an injection for months, while others may need to stay on it for years.
Sublocade Injections Increase Sobriety Success Rates
According to the manufacturer, in one clinical study, people treated with Sublocade were fourteen times more likely to complete their treatment programs and stay sober. 28% of people who got therapy/treatment alongside their MAT stayed sober for at least 24 months.
In the study, the group that was given a placebo only had a 3% success rate over the same period. While some people did relapse in the more successful group, everyone who stayed sober for at least 80% of those 24 months did so with the help of Sublocade.
Consider Sober Living
If you or somebody you love needs a safe space to lay their head, sober living may be the healthiest choice. Living in an environment where people work toward positive change can be inspiring and help you stay focused on your goals. Learn more about our communities by calling us at 760-216-2077.
For many people with opioid use disorder, Medication-Assisted Treatment (MAT) such as Suboxone or Vivitrol is a lifeline to long-term sobriety. While MAT is not the best option for everyone, thousands of people across America have used it in one form or another to help put distance between themselves and their last use of illicit drugs.
Becoming Familiar With MAT
MAT is considered an important tool for people with opioid use disorder. The recovery community has not necessarily embraced it as the go-to tool for addiction recovery, mainly due to worries about its safety. Many people who got sober without the aid of MAT may have reservations about its use. However, the FDA has recently recommended the use of agonist or partial agonist medications (methadone, buprenorphine) to support abstinence. Through this endorsement, more treatment centers have decided to add MAT as a tool for people new to recovery.
Like all treatment tools, MAT is an option, but it’s not the only way people can get and stay sober. We’re fighting a deepening opioid crisis, and treatment providers, as well as their clients, deserve to have as many tools at their disposal as possible. MAT definitely can provide a life-saving function for people who suffer from opioid dependence and addiction.
It is the role of the treatment providers and medical professionals to learn the facts about how medications work and find ways to support long-term recovery for individuals using these medications. This education on MAT includes those who run sober homes and housing programs for people in recovery.
According to data from 2018 gathered by the National Institute on Drug Abuse (NIDA), 128 people in the United States die from opioid overdoses every day. Medication-Assisted Treatment has helped thousands of people beat those odds by reducing cravings and assisting individuals to put more time between themselves and their drug of choice.
Guidance For Treatment Providers, Sober Housing, And Others
New guidance has been released by NIDA to help addiction treatment providers understand the ins and outs of prescribing and helping people use MAT as a part of their overall treatment plan.
While all treatment providers and sober housing professionals have their own programs that help them build a safe community, this information is vital to assisting professionals to make the right choice for their clients to begin their journey in recovery.
The guidelines brief attached can help sober living homes and other providers understand where MAT fits into an overall treatment plan. While MAT is still new to the sober housing community, it has been safely used in treatment facilities for a number of years. Understanding what role it can play will help housing communities draft their own policies based on science and information on treatment outcomes.
About the National Association of Recovery Residences (NARR):
NARR's mission, according to their website, is "to support persons in recovery from addiction by improving their access to quality recovery residences through standards, support services, placement, education, research, and advocacy."
About By the Sea Sober Living
Now, more than ever, it’s important to have people in your life who support your recovery. Sober living situations are a great way to rebuild your life and adjust to working on your new goals. Learn more about how our sober home can help you in your recovery. Call us at 760-216-2077 to learn about housing options.