Buprenorphine deaths did not increase despite wider access during pandemic, study shows

The onset of the Covid-19 pandemic led to a sea change in addiction medicine — in particular, increased access to buprenorphine, a drug commonly used to treat opioid use disorder.

Now, new data show that despite the medication’s wider availability, deaths involving buprenorphine still constitute a small fraction of overall drug mortality.

The research, published Friday in JAMA Network Open, offers new insight into the impact of emergency policies enacted in early 2020 to slow Covid’s spread while preserving access to addiction care. The changes allowed doctors to issue new buprenorphine prescriptions via telemedicine, making the medication far more accessible for patients in rural areas or without access to transportation.

Buprenorphine, however, is itself an opioid, and is regulated as a controlled substance. While most doctors and health officials welcomed the changes, a small minority expressed concern that increasing buprenorphine access could have unintended consequences.

Those concerns were largely unfounded, according to the new research, which was authored by top addiction researchers at the Centers for Disease Control and Prevention and the National Institute on Drug Abuse.

While deaths involving buprenorphine did tick upward in the months following the policy changes, they increased at a significantly lower rate than overall drug deaths. Between July 2019 and June 2021, the share of opioid-related deaths involving buprenorphine dropped from 3.6% to 2.1%.

Among those who died of buprenorphine-involved overdoses, just 20% were specifically receiving medications used to treat opioid use disorder, meaning the drug was likely acquired illegally.

More broadly, nearly 93% of deaths involving buprenorphine also involved other substances, meaning that fewer than 1 in 600 opioid-involved deaths is attributable to buprenorphine alone.

The study’s publication comes amid a broader movement to increase access to addiction medications. In December, Congress passed legislation eliminating a requirement that doctors wishing to prescribe the medication obtain a special license known as an “X-waiver.”

Federal regulators also announced plans to make the emergency telehealth provisions enacted in 2020 permanent. In addition, Covid-era rules allowing patients to take home weeks’ worth of methadone, another common and highly effective treatment for opioid addiction, will also become permanent. A similar study published last year showed that methadone-related deaths did not increase despite the new flexibilities.

Still, access to buprenorphine is not without its challenges. Some pharmacies have reported that the Drug Enforcement Administration still conducts raids on facilities filling telemedicine prescriptions for buprenorphine, despite the new rules.

Separately, doctors across the U.S. have reported increased difficulty with buprenorphine “inductions,” or the process of giving patients their first dose. As the drug supply has become more contaminated by fentanyl, buprenorphine has become more likely to cause severe withdrawal symptoms, leading patients to seek treatment using alternatives like methadone — or avoid treatment altogether.

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