Buprenorphine Expands Access to Addiction Treatment


Reuter says it is notable that the drug made its way from zero patients eight years ago to more than a half a million today. But that rate of expansion is nowhere near that of drugs for chronic conditions like heart disease or diabetes. For example, a drug like rosuvastatin (Crestor) for lipid-lowering topped the million prescription mark within months of hitting the market.

Nor has buprenorphine kept pace with the rising epidemic of opioid abuse, Kolodny said. SAMHSA estimates that between two and six million patients in the U.S. abuse opioids, and there's at least an equivalent number of heroin addicts.

Expanding Access to Buprenorphine

Northern Arizona is mountainous, rural, and not remotely related to the urban world of Kolodny. Like many rural areas, the prescription painkiller epidemic is rampant, but the region's only methadone clinic is in Flagstaff and there is just one physician certified to prescribe buprenorphine.

The person is Dr. Sue Sisley, and her neighborhood is several hundred square miles of Arizona territory.

But technology allows Sisley to make house calls even when the house is more than 150 miles away from her desk. She treats patients via a telemedicine program at the University of Arizona.

In some ways, telemedicine can be more intimate than the in-person experience, Sisley says.

To illustrate, she tells the story of one of her patients, a concert pianist who had become addicted to opioid painkillers. He was, she said, so disgraced by his addiction, that he refused to even touch the keys on his piano. She prescribed buprenorphine.

Then, during a video follow-up after starting on the drug, he angled the camera toward the instrument and started playing.

"It was amazing," Sisley said. "It couldn't have happened without telemedicine."

Kolodny is working with Sisley to bring her telemedicine services to West Virginia -- a partnership that was partially facilitated by a buprenorphine patient in that state.

Bondina Stone is a registered nurse in the rural Appalachian town of Mineral Wells, W.Va., which she says is mired in the OxyContin epidemic.

Stone's own struggle with addiction began after a 1993 accident that left her in severe pain. She was on and off painkillers for years, sometimes after unsuccessful attempts at treatment with methadone.

Finally, in 2008, she was able to get a prescription for buprenorphine.

"If changed my life," she told MedPage Today. "I'm productive now. I work, I'm a full-time mother. I can focus on what I need to do in life, rather than on how I am going to make it to the clinic tomorrow."

Her take on buprenorphine: "It makes you feel normal," unlike being on methadone, where "you still get a little high."

Carolyn Alfieri, a buprenorphine patient from Long Island, cautioned that successful treatment largely depends on the patient's own drive to stay clean. She had one unsuccessful run with buprenorphine, falling back to old habits after an old friend sent her a "package" in the mail.

But the second time was the charm for Alfieri, and she has now been opioid-free for two and a half years.

"In my opinion, buprenorphine is a lifesaver," she said. "I'm not panhandling, I'm not pawning my mother's wedding ring. I'm getting the trust of loved ones back."

Buprenorphine 'Its Own Worst Enemy'

That's not to say buprenorphine is without drawbacks.

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