Lifesaving Medicines for Underprescribed Opioid Use Disorders in the United States


Disclosures: Xu does not report any relevant financial information. Please see the study for relevant financial information from all other authors.

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Buprenorphine, a life-saving drug for opioid use disorder, is underused by doctors, researchers say.

Kevin Xu, M.DMPH, a resident physician in psychiatry at Washington University School of Medicine in St. Louis, and his colleagues found that buprenorphine, which has been shown to reduce the risk of overdose, was only prescribed to about half of patients in the United States who sought treatment for opioid use disorder (OUD). The number was even lower for people with polydrug use disorder – a disorder in which opioid users also abuse other substances – at around 30%.

“This equates to giving people with advanced cancer a less aggressive treatment,” the lead researcher said. Laura J. Bierut, MD, Alumni Endowed Professor of Psychiatry at the University of Washington, said in a press release about the study. “It seems obvious to many of us that we should give the most aggressive and effective treatments to those who are most seriously ill.”

Xu and colleagues conducted an observational competitive efficacy trial that used 5-year insurance claims to study drug initiation for OUD (MOUD) in patients seeking treatment.

Of the 179,280 people with OUD, 102,930 received psychosocial treatment without MOUD, or about 57.4%.

Among 47,488 people with concurrent substance use disorders (SUDs), 33,449 – or 70.4% – did not receive MOUD. Comparatively, only 52.7% of people without concurrent SUD did not receive medication.

Xu said in the press release that he was concerned that “the majority of people who abuse multiple substances don’t seem to be getting the life-saving drugs they really need.”

The researchers also note, however, that concurrent SUD was associated with a decreased odds of initiating buprenorphine (RR=0.55; 95% CI, 0.54-0.56) but an increased odds of ‘initiate naltrexone (extended release: RR=1.12; 95% CI, 1.05-1.2; oral: RR=1.95; 95% CI, 1.86-2.03),” despite the protective associations of buprenorphine against drug poisoning”.

In a subcohort of 12,485 people who were treating their disorder with MOUD and experienced at least one drug-related poisoning while enrolling for insurance, researchers found that buprenorphine treatment days were associated to a decrease in poisonings compared to days without MOUD for people with concomitant SUD (OR = 0.56; 95% CI, 0.48-0.65) and without concomitant SUD (OR = 0.57; CI at 95%, 0.53-0.63).

Overall, the results suggest, according to the study authors, that people with UUD and polysubstance use were “less likely to initiate buprenorphine and naltrexone than people without polysubstance use.”

One explanation for this, Xu said in the statement, is that buprenorphine is an opioid, and so doctors may be hesitant to prescribe it to people with OUD. Additionally, buprenorphine does not require daily trips to a clinic and can be taken at home. This “lack of oversight, along with a lack of data on the drug’s effectiveness in those with multiple substance abuse,” means some doctors are “reluctant to prescribe it,” according to the press release.

“Buprenorphine seems [be] a safe opioid,” Xu said in the statement. “It is specifically designed to be different from other opioid medications in that it will not cause the user to stop breathing, which just about every other type of opioid will. This means it can be taken safely at home, which is very helpful, if not essential, for recovery.

Although the other drug examined in the study, naltrexone, also reduces the risk of future overdoses, Xu said “recent data suggest that buprenorphine is significantly more effective.”

“Now the challenge will be to convince more doctors to prescribe this safe and effective drug to patients who need it,” he said.


Drug that reduces the risk of underused overdose. Published May 10, 2022. Accessed May 19, 2022.

Xu KY, et al. JAMA Netw Open. 2022; doi:10.1001/jamanetworkopen.2022.11363.

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