How Can Injectable Buprenorphine Help Lower the Risk of Overdose in California?

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Opioid overdose rates in California have been rising for years. In 2020, there were 5502 opioid overdose-related deaths in the state and 16,537 emergency department visits.

Since the onset of the nation’s opioid public health crisis in the 1990s, billions of dollars of public funds have been committed to opiate use disorder treatment and recovery. Scientific research has uncovered various medications that can reduce cravings, ease withdrawal symptoms, and decrease the risk of opioid overdose.

One of these medications is buprenorphine. Buprenorphine is an opioid agonist that binds to opioid receptors, mimicking the action of opioid drugs like fentanyl, oxycodone, and heroin but with a weaker euphoric response. Taking buprenorphine prevents other opioids from binding to receptors, reducing the risk of an overdose from street drugs.

The cheaper version of buprenorphine – the oral version of the drug – consists of a pack of tablets that you have to take daily. However, staying in this kind of treatment requires commitment and dedication. Many people who are addicted to opioids, especially the street homeless, may not be able to religiously take a table each morning. Unfortunately, a large number of people fall out of treatment.

On the other hand, the injectable version of the medicine only requires one administration per month, between which the individual is fully protected. However, it comes with a cost  – Sublocade, which received FDA approval in 2017, has a list price of $1,829.05 per injection. There are currently no competing or generic versions.

While Medi-Cal and most other health insurance schemes cover some or all of the costs of the treatment so patients will not pay the total price, some private insurance plans may not include the medication. Moreover, Sublocade is a controlled substance that comes with its regulatory hurdles, limiting the dispensation of the drug. Providers have to register with the Drug Enforcement Administration and obtain a waiver to dispense it, while clinics have to participate in an FDA certification program.

All these things can restrict access to the drug. There may be a delay in the time it takes for hospitals to acquire it, or they may choose not to offer it at all. Even with the oral version of buprenorphine, there remain problems. Many patients struggle to find either form of the drug, especially in communities of color.

Many healthcare workers are adamant that this needs to change. Given the years of scientific research supporting medication-assisted treatment (MAT) for opioid use disorders, they argue that this medication shouldn’t be more difficult to obtain than it is for other diseases. Many patients may become interested in other things as they wait to receive prescriptions, potentially putting their lives at risk.

Why Are Overdose Rates in California so High?

A 2021 report found that 1500 people died on the streets of Los Angeles during the pandemic, most of whom are believed to be homeless. Around 40% died from a drug overdose. These numbers are probably an underestimate.

Across the country, over 100,000 people died in the year ending in April 2021, an increase of 28.5%. Overdose deaths from pain prescription, natural, and synthetic opioids all increased. In California, fentanyl deaths are particularly high, increasing five-fold from 2018 to 2020.

Most people observed the beginning of the opioid drug epidemic in the proliferation of opioid painkiller prescriptions at the end of the 1990s. At the time, pharmaceutical companies persuaded healthcare providers that the drugs could be prescribed safely, without a high risk of addiction. In the following years, millions of Americans developed opioid addictions.

Despite the investment of huge amounts of public funding into better prescription practices, prevention strategies, and treatment services, the drug epidemic continues. There were still over 14 million opioid painkiller prescriptions dispensed in 2020.

The California Department of Public Health (CDPH) recognizes that opioid abuse and overdose are intertwined with other trends in the region. As rates of homeless, mental illness, despair, and social inequalities have risen, so have opioid rates – particularly among marginalized groups.

The staggering numbers of overdose deaths are likely to continue to increase. The proliferation of fentanyl, an opioid that is 50 times stronger than heroin and 100 times stronger than morphine, is a main driver of deaths. Even small amounts of fentanyl can be deadly, and it is often mixed with other substances, unknown to the user.

How Are the Authorities Tackling the Problem?

The development and distribution of life-saving medicines like buprenorphine is an important part of tackling the epidemic. Alongside funding medical research, the state of California engages in several other prevention and treatment strategies. These include:

  • Expanding knowledge and education for providers of opioids
  • Increasing access to and effective use of naloxone, a drug that can reverse opioid overdose
  • Building public health services, capacity, and supportive policy amongst communities

In 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that California would receive $210 million over the next two years as part of the FY 2020 State Opioid Response (SOR) grant program. The grant will fund several projects, including:

  • Developing hospitals into primary access points for treating opioid use disorder (OUD) and other substance use disorders, offering individuals medication for OUD in the emergency room and connecting them with ongoing community care
  • Expanding access to medications for addiction through narcotic treatment programs (hubs) and smaller clinics (spokes) that provide ongoing care and maintenance treatment
  • Providing medication in county jails, and working to create a support system for individuals receiving treatment
  • Directing resources to Tribal and Urban Indian communities, including culturally informed naloxone distribution and training

State authorities and Californian citizens all hope that these changes will bring down overdose rates – and medications like injectable buprenorphine may play a big part. However, public health workers warn that given the steeply increasing statistics, the numbers may get worse before they get better.

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