Barriers to buprenorphine increasing risk of drug overdose

13 Feb 2022

Health alert from Oregon Health Authority

The Oregon Health Authority has become aware that some individuals needing to fill prescriptions for buprenorphine, an FDA-approved medication for opioid use disorder sold under the brand names Subutex and Suboxone, may be facing increased access barriers. This is primarily because their pharmacy has run out of supply. This is not a manufacturing supply chain issue, but rather a pharmacy access and client access issue.

Buprenorphine is an opioid partial agonist that produces effects such as euphoria or respiratory depression at low to moderate doses. However, these effects are weaker than full opioid agonists such as methadone and heroin, making buprenorphine a lower diversion risk.

The sustained, alarming increase in overdose deaths in recent years has highlighted the need for more accessible treatment services, and studies have shown that medication-based treatment promotes long-term recovery from opioid use disorder.

Implications on health of individuals and health care:

1. The inability to refill buprenorphine could result in clients going to emergency departments or accessing emergency medical services while in opiate withdrawal, or after an overdose.
2. Individuals may also be at a greater risk for turning to illicit opioids to reduce withdrawal symptoms and increases their risk of overdose. Overdose risk is drastically increased by the increasing availability of illicitly manufactured fentanyl, often found in counterfeit pills.

We ask our partners to remain particularly vigilant during this time that barriers to buprenorphine may increase the potential for drug overdose.

Naloxone, also known as Narcan, is a drug that can reverse an opioid overdose. If you would like to become familiar with how to access naloxone in your community, please reach out to Erin Porter (erin.porter@dpsst.oregon.gov). 

Factors contributing to access barriers, and areas with potential for pronounced effects:

1. The DEA has communicated that they will have heightened scrutiny on “large” orders of opioids from pharmacies and pharmacy chains. This communication did not explicitly exclude buprenorphine for opioid use disorder. This has resulted in manufacturers limiting the amount of buprenorphine sent to pharmacies.
2. With the closure of BiMart pharmacies, the number of pharmacies in some counties, and for some CCO pharmacy networks, has significantly reduced.

• Based on what we know about the pharmacy closures, we anticipate that patients seeking buprenorphine in the following counties may face the highest barriers to access: Lane, Umatilla, Deschutes, Douglas, Baker, Jackson, Coos, Linn, Marion, Klamath and Union.

Steps being taken to address the issue:

1. OHA is in conversation with the US Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA).
2. OHA is exploring purchasing options to help get buprenorphine to pharmacies.
3. OHA is working with CCOs to address the pharmacy network barriers.
4. OHA is making naloxone more readily available through the Save Lives Oregon website.
5. OHA has created a summary of overdose-related services & projects by county. 

For treatment providers, if you are concerned your clients may be at risk of relapse or overdose:

• Talk with them about creating a plan to reduce their risk of relapse. Remind them that relapse doesn’t mean they have failed.
• Talk to your local pharmacies and treatment providers to help ensure that naloxone is available.
• If you or someone you know uses illicit opioids, remember to have naloxone on hand, don’t use alone, and use slowly (you can always use more drugs, but you can’t use less).
• Research available harm reduction services in your area and refer client as necessary.

Consider reaching out to the nearest outpatient opioid treatment program (OTP) to help clients access crucial medications.