Why Is Buprenorphine Not Used More For Opioid Addiction?

Although the U.S. government had partly funded buprenorphine’s development as a treatment for opioid addiction, France was one of the first countries to exploit the drug’s potential fully. In the 1990s, French health authorities began allowing any doctor to prescribe buprenorphine. By the early 2000s, overdose deaths there from heroin and other opioids had declined by nearly 80 percent. Andrew Herring of Highland Hospital in Oakland, Cal., decided to try the drug in his emergency room. Herring and his colleagues established what is now called the Alameda Health System Bridge Clinic, an addiction-treatment program that has become a model for hospitals and physicians in California and other states, the New York Times Magazine reports. In 2022, more than 107,000 Americans died from drug overdoses, most of them from fentanyl, a fatal-overdose rate nearly quadruple what it was 20 years earlier.

Over time, opioid users have transitioned from taking prescription drugs like OxyContin to heroin to the fentanyl that now dominates the illicit drug market. Many see illicit fentanyl, said to be 50 times as powerful as heroin and 100 times as powerful as morphine, as the worst drug epidemic the U.S. has ever seen. At the same time, experts have reached a consensus: Medication-for-addiction treatment, using medicine like buprenorphine or methadone to help patients recover from their opioid-use disorder rather than trying to get them to quit cold turkey, is the best course of treatment. t the drug remains drastically underprescribed. Only between 10 and 27 percent of those who could potentially benefit from it — people using a variety of illicit opioids, but especially fentanyl — are taking it. Experts cite many reasons buprenorphine has not been adopted more quickly: limited funding; onerous regulation; doctors’ lack of familiarity with it; the hesitation by hospitals and other health care providers to fully engage with the specialty of addiction medicine; and persistent stigma. Buprenorphine belongs to the same class of drugs as the painkillers and illicit opioids that have led to much anguish in the first place, likely causing many physicians to avoid it reflexively. As an opioid, it’s monitored by the Drug Enforcement Administration, which further bolsters doctors’ reluctance. “Our big project,” Herring says, “is to free buprenorphine.”