LANSING – A third of telemedicine patients with opioid use disorder in Michigan had to go without their recovery medication because of trouble filling prescriptions at a pharmacy, according to a recent study.
Patients were most likely to say they had to forgo buprenorphine, a medication that helps people recovering from opioid addiction avoid withdrawal symptoms, reduce cravings and prevent them from using opioids again.
The study surveyed 600 telemedicine patients across five states: Florida, Michigan, New Jersey, Ohio and Texas.
In Michigan, 36.9% of patients said they had to go without buprenorphine. Patients in Ohio were the least likely to say they had to go without buprenorphine, at 27.3%.
In many states, buprenorphine is in stock at pharmacies only about half of the time, and roughly one in five pharmacies are unwilling to order it, said Lucas Hill, a coauthor of the study.
“Even needing to wait until a day or two for the pharmacy to order the medication – if that leads to a gap, that person is likely to experience really uncomfortable withdrawal symptoms and be triggered to use a dangerous illegal drug,” said Hill, a pharmacist and an associate professor at the University of Pittsburgh.
About a quarter of patients in the overall study said they had to go without buprenorphine for seven or more days.
The most common reason patients couldn’t get medication was because it wasn’t in stock, according to the study published in the medical journal JAMA Network.
Reasons include federal limits imposed on pharmacies in ordering controlled substances such as buprenorphine, he said.
Stigmatization surrounding buprenorphine and the patients who use it also plays a role in accessibility. Those regulations are an easy excuse for pharmacists not to order or supply buprenorphine in the first place, he said.
“It’s easy for them to blame it on those regulatory or financial concerns,” Hill said.
At the national level, other states face similar challenges to Michigan’s, said Marlene Lira, the lead author of the study. She is an epidemiologist and senior director of research at WorkIt Health, a multistate telehealth provider of treatment for opioid use disorder.
The federal regulations that are unintentionally creating problems were put in place in response to the opioid public health crisis, she said.
“The idea was pharmacies should be limited and should be provided oversight so we don’t have that same large-scale prescribing of controlled substances again,” said Lira. “And this sounds like a very noble cause – however the issue is that buprenorphine is a controlled substance.”
Michigan has been disproportionately negatively affected by the opioid public health crisis in comparison to other states, said Cara Poland, the chair of the state’s opioid advisory commission and an associate professor in the Michigan State University College of Human Medicine.
“Every six hours in Michigan, someone dies of an opioid overdose,” she said.
Over the last year, however, deaths from opioid overdoses in Michigan have decreased, due in part to naloxone distribution led by the state Department of Health and Human Services. Naloxone is a life-saving medication that reverses an opioid overdose.
“We’ve seen a 37% reduction in opioid overdose deaths, putting us as one of the leading states in reducing the opioid death rate,” Poland said.
That’s why accessibility to buprenorphine is so important, because it significantly helps patients with opioid use disorder receive treatment while they go through recovery, she said.
Poland said she has helped develop bills in the Legislature to address the problem, she said.
One of the bills would require pharmacists to fill a prescription without undue delay and another would eliminate preauthorization for recovery medications, she said. Both passed the Senate and are awaiting action in the House Insurance Committee.
Sponsors include Democratic Sens. Sylia Santana of Detroit, Sam Singh of East Lansing and Kevin Hertel of Saint Clair Shores.
Poland said, “If we want to further impact the death rate, we need to ensure that medications are available to people when they want them and when they need them in a timely manner.”
Buprenorphine is not a drug that regularly gets abused. Even if patients do sell or share the drug that’s prescribed to them, in a majority of cases those other people are also using it as treatment, said Hill.
Hill said there have been proposals at the federal level to declassify buprenorphine as a controlled substance because of how safe it is. He said he thinks that regulatory change is warranted.
Changes in regulation would take away a convenient barrier or excuse for pharmacists who don’t want to sell or stock it. That could lead to legal action, like civil rights cases for access to appropriately prescribable medication, Hill said.
Some pharmacies also limit the ability of patients to get a refill early. Hill said that can cause timing difficulties for patients.
