As drug overdoses rise with the pandemic, two studies show addiction medication can save lives

Two new studies funded by the National Institutes of Health show how expanding access to medications that treat addiction has become crucial in fighting America’s overdose crisis, which recently broke a record for the most drug deaths ever recorded in a 12-month period.

The first study, conducted by Duke University researchers and published in the journal Addiction this week, followed people taking the opioid addiction treatment drug buprenorphine. Instead of being treated at a doctor’s office, participants in the study were able to get care at a community pharmacy.

Until Thursday, buprenorphine, itself an opioid, was heavily regulated by the federal government; physicians were required to obtain a special license to prescribe it for people in addiction. Even among those who could, about half didn’t prescribe it anyway. As such, more than 20 million Americans lived in counties without doctors who could prescribe buprenorphine, said Nora Volkow, the director of the National Institute on Drug Abuse.

On Thursday, the federal department of Health and Human Services — citing skyrocketing overdoses during the pandemic — relaxed regulations around buprenorphine, requiring prescribers to possess only a state physicians license and a Drug Enforcement Administration registration, which most physicians have.

The study, conducted before those regulations were changed, noted that while many people don’t live near a buprenorphine prescriber, nearly everyone lives close to a community pharmacy. So Duke researchers transferred the care of 71 patients in the Raleigh-Durham, N.C., area from doctors to local pharmacists. Doctors still helped patients reach a stable dose of the medication, but pharmacists handled monthly maintenance care, where patients got their medication as well as counseling and specialist referrals.

The results were promising: Nearly 89% of patients stayed in the study and more than 95% took their medication daily. Ninety percent found that the treatment from pharmacists was no different from what they’d received at a doctor’s office, and said it was “extremely convenient” to get addiction treatment at the same place where they picked up their addiction medication.

“Letting patients follow up at the local pharmacy would significantly expand treatment access in the United States,” Volkow said Wednesday. “In rural communities, this is a major issue. Patients have to travel miles and miles to get to a provider.”

A second study, from the University of Texas Southwestern Medical Center, tackled treatment for methamphetamine addiction, which has almost no treatment medications. The study, published Wednesday in the New England Journal of Medicine, found that a combination of naltrexone, an opioid-blocking drug, and bupropion, an antidepressant known commercially as Wellbutrin, helped more people with meth use disorder stay off the drug than those in a placebo group.

Just over 13% of participants who received naltrexone and bupropion — also prescribed as a stop-smoking drug under the brand name Zyban — turned in at least three out of four negative drug tests at the end of the six-week trial, compared to only 2.5% of patients who received a placebo.

Finding a drug combination that could successfully treat methamphetamine addiction is significant simply because there are so few medication options for people addicted to stimulants, Volkow said. That’s particularly concerning as meth use rises around the country, and as stimulants are increasingly contaminated with the deadly synthetic opioid fentanyl. In Philadelphia, stimulant overdoses have been rising for years, particularly in combination with fentanyl.

Nationally, methamphetamine-related overdoses have risen fourfold in the last 10 years, Volkow said. Half of those overdose victims had also ingested fentanyl.

“Opioid withdrawal is something we have learned to manage quite well with medicine — we can stabilize very unpleasant sensations,” Volkow said. “But in the case of meth addiction, we don’t have a way, pharmacologically, until now, to mitigate the distress that happens during the state of withdrawal and intense craving.”

Because both bupropion and naltrexone are already approved by the Food and Drug Administration, Volkow said physicians can prescribe the medications off-label to patients looking to decrease or stop their meth use. However, insurance providers will likely not cover the treatment. She said NIDA officials plan to meet with the FDA to design another clinical trial with the aim of getting both drugs approved to treat meth addiction.