Flexible Prescribing Did Not Increase Buprenorphine Overdose Deaths

Despite common misconceptions, researchers published an article in JAMA Network Open noting that buprenorphine overdose-related deaths did not increase during the COVID-19 pandemic when providers were allowed flexible prescribing.

According to the publication, the standard prescribing rules for buprenorphine, also known as Burprexnex, Suboxone, Zubsolv, or Sublocade, allowed the drug to be prescribed in offices that had completed a Drug Addiction Treatment Act waiver. This waiver made them eligible to prescribe to 30, 100, or 275 patients, depending on each facility’s specific waiver classification. However, when stay-at-home orders were implemented during the COVID pandemic, the government allowed providers who had a waiver to prescribe the medication after a virtual visit, no longer requiring a physical exam.

While necessary at the time, many were concerned that virtual prescribing would be associated with higher overdose and overdose-related death rates. To determine whether this was true, researchers conducted a cross-sectional study using data from the State Unintentional Drug Overdose Reporting System (SUDORS) from July 2019 to June 2021.

The study determined that there were 74,474 opioid-involved overdose deaths during this time, with only 1,955 buprenorphine-involved overdose deaths. According to the publication, buprenorphine-involved overdose death only accounted for 2.2% of all overdose deaths and 2.6% of all opioid-involved overdose deaths.

According to the data, women were slightly more likely to die from buprenorphine-related overdose than other opioid-related overdoses. Additionally, White individuals were roughly 16.7% more likely to die from using buprenorphine than other opioids.

Looking at overall trends in the span of the study, researchers noted an increase in the number of opioid overdoses each month. Conversely, while the number of buprenorphine overdoses fluctuated each month, the overall proportion did not increase throughout the study time. Additionally, researchers note that over 90% of buprenorphine-involved overdose deaths involved another drug. 

Researchers in the publication concluded, “The findings of this cross-sectional study suggest that actions to facilitate access to buprenorphine-based treatment for opioid use disorder during the COVID-19 pandemic were not associated with an increased proportion of overdose deaths involving buprenorphine. Efforts are needed to expand more equitable and culturally competent access to and provision of buprenorphine-based treatment.”