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Legal Limitations Associated with Microdosing Buprenorphine
Barbara Andraka-Christou1,2, Matthew Douglas Evans3, Beth Tranen4
1School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida, USA.
Substance Use & Misuse
|April 7, 2023
Summary
Federal laws hinder the Bernese method for opioid use disorder treatment. Allowing short-term fentanyl dispensing could improve buprenorphine induction and reduce overdose deaths.
Area of Science:
- Addiction Medicine
- Pharmacology
- Public Health Policy
Background:
- Opioid overdose deaths are rising, driven by illicit fentanyl.
- Buprenorphine is effective for opioid use disorder but induction is challenging for fentanyl users.
- Precipitated withdrawal risk complicates buprenorphine initiation.
Purpose of the Study:
- To analyze how federal laws impede the Bernese method.
- To propose legal reforms for facilitating the Bernese method.
- To improve buprenorphine induction for patients misusing fentanyl.
Main Methods:
- Commentary on existing federal regulations.
- Analysis of the Bernese method's requirements.
- Identification of legal barriers to short-term fentanyl administration.
Main Results:
- Federal law prohibits office-based prescribers from administering fentanyl for buprenorphine induction.
- This forces patients to obtain illicit fentanyl during the induction phase.
- Current regulations inadvertently create barriers to a potentially life-saving treatment approach.
Conclusions:
- The Bernese method offers a way to manage fentanyl misuse during buprenorphine induction.
- Federal law reform is needed to permit controlled, short-term fentanyl dispensing.
- Policy changes can enhance access to effective opioid use disorder treatment.
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