Should Opioid Addiction Treatment Drugs Be Sold Over the Counter?
In the last few years, new voices have been heard, calling for opioid treatment drugs to be made available in pharmacies to anyone who asks for them. Up to this point, these drugs have only been available by prescription. Those entitled to prescribe these drugs have been limited to licensed medical professionals who have been authorized to do so by the Drug Enforcement Administration.
This proposal has generated significant controversy in the medical and addiction treatment fields. Understanding the controversy and coming up with the right answer to the proposal requires a fairly thorough investigation of the issues surrounding this proposal.
About Opioid Addiction Treatment Drugs
Which drugs are included in this discussion? Opioid addiction drugs include these:
- Buprenorphine alone, brand-named Subutex, as sublingual (under the tongue) tablets.
- Buprenorphine and naloxone, brand-named Suboxone, in film or tablet form. The addition of naloxone is intended to discourage misuse.
- Time-release injection of buprenorphine, brand-named Sublocade.
- Naltrexone, a time-release injection, brand-named Vivitrol.
The primary drug recommended for greater availability is buprenorphine, an opioid drug that is also used for pain relief. It creates many of the same effects as other opioids, including constipation, dizziness, drowsiness, respiratory distress, overdose and dependence. For that reason, its use is limited by law and only qualified medical practitioners are allowed to prescribe it.
When buprenorphine is employed in the treatment of opioid addiction, its use is begun after the individual has started to suffer symptoms of withdrawal. Buprenorphine is administered and the person’s need for opioids is satisfied and withdrawal symptoms will stop.
If the person stops taking buprenorphine suddenly, they will still go into withdrawal. Buprenorphine products may be prescribed temporarily while a person waits for an opening at their preferred drug rehab or as a long-term (even life-long) regimen. The choice is up to the medical professional caring for the addicted person.
Efforts to Resolve the Loss of Life Due to Opioid Overdoses
Nationally, intense efforts have been underway for years to try to stem the massive loss of life resulting from opioid overdoses. The total number of overdose deaths has increased from less than 50,000 in 2015 to 109,000 in 2021. More than 75% of these deaths are now caused by prescription or illicit opioids. As of November 2022, America was on trend to lose another 108,000 for the year.
Definitely, there needs to be an effective solution to this devastating problem. Would making opioid addiction treatment drugs available over the counter be the right solution?
Why Increase Buprenorphine Availability?
Advocates for this change state that a person who is addicted to opioids can go into a pharmacy and request buprenorphine at any time, enabling them to stop using powerful and deadly drugs like fentanyl. Laws permitting this easy access could mandate a limit on the number of days’ worth of the drug sold, perhaps to a few days’ worth. That would give a person time, advocates say, for them to seek out a practitioner who might begin a long-term prescription of this medication.
Alternately, a person who was previously addicted to opioids and who felt they were on the brink of relapse could easily obtain this controlled dosage of an opioid.
It would be a mistake, however, to be convinced about the benefits of over-the-counter buprenorphine without looking at the possible hazards of such a move.
Arguments Against Increased Buprenorphine Availability
The drug also causes dependence. That means that a person’s body becomes accustomed to this drug, just like it does with morphine, oxycodone or heroin, and will go into withdrawal sickness if use is terminated. In fact, a buprenorphine user easily becomes addicted to this drug after using it for a while.
There is also concern that easily-accessible buprenorphine could serve as a gateway drug for new users. A person who is not accustomed to using opioids can experience euphoria when buprenorphine is consumed. If that euphoria is desirable, they may try to go from pharmacy to pharmacy to obtain more. It is also easier for a person new to opioids to fatally overdose as they have developed no tolerance for the drug.
There are also some people who should not be given opioids, such as people with breathing problems, sleep apnea or liver or kidney problems. Mixing opioids with other medications like benzodiazepines or with alcohol can also cause a person to suffer fatal effects.
Buprenorphine products are frequently diverted to the illicit market. Some people want these drugs to self-medicate or as an alternative to other opioids if availability is low at the moment. Making buprenorphine products freely available is likely to increase the quantity of this drug being distributed by drug dealers.
Proper Supervision and Support Needed During Recovery
The National Institute on Drug Abuse provides important guidelines on what is involved in helping a person recover from an addiction to opioids or any drugs. NIDA says:
Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual’s life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society… Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment. Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships.
In a pharmacy setting, this multi-dimensional care cannot be provided. Blood tests to check for liver or kidney problems are not available. By simply dispensing the drug and not being able to follow up with the patient, it is not possible for pharmacists to monitor the proper use of these medications or to ensure that the drugs do not make their way to the illicit market.
Opioid treatment drugs are powerful medications. Prescriptions for these drugs must be judiciously handed out. Once these drugs are being used by a patient, the short and long-term effects must be carefully monitored. And perhaps most important of all, the many needs of an addicted person must be met, not just one.
Will a pharmacist by virtue of their training, access to a patient’s medical information or available time during their workday be able to provide the appropriate level of care for a person who is addicted to opioids?
More Help and Recovery Support are Definitely Needed
It’s true that more access to recovery programs and sober support is needed to help millions of Americans exit their addictions and create lasting, productive and enjoyable lives for themselves. Those who are addicted and their families need access to well-rounded recovery programs that meet all the requirements described by NIDA.
When we help those who are trapped in addiction, that help should encourage and enable each person to regain a healthy ability to break their reliance on drugs and create new, sober lives for themselves.
- Centers for Disease Control and Prevention. “Provisional Drug Overdose Death Counts.” CDC, 2023. CDC.
- Tennessee Department of Health. “TDH Finds Some Overdose Deaths Associated With Buprenorphine.” TDH, 2018. TDH.
- National Library of Medicine. “Offering Emergency Buprenorphine Without a Prescription.” NLM, 2019. NLM.
- Veterans Administration. “Safe and Responsible Use of Opioids for Chronic Pain.” VA, 2018. VA.
- National Institute on Drug Abuse. “Principles of Drug Addiction Treatment.” NIDA, 2014. NIDA.