Medication-based treatment is the gold standard for treating opioid use disorder (OUD) – yet patients often struggle to access it.
Some people seeking buprenorphine, one type of MOUD, turn to diverted medications, which are prescriptions not originally intended for that person.
New research shows that almost half of patients who enter virtual OUD treatment were already taking buprenorphine – and that nearly 40% of those patients obtained buprenorphine not prescribed for them. That’s according to a new study published in Substance Use & Misuse, authored by researchers affiliated with OUD treatment provider Bicycle Health.
“When you talk about expanding access to medications for OUD like buprenorphine, the question of diversion always comes up,” Dr. Brian Clear, chief medical officer of Bicycle Health, said in a statement. “But the reality of diverted buprenorphine is often much different than that of other controlled substances. We’ve continued to see that when people are ready for recovery, they turn to whatever they can most easily access to get there.”
Boston-based Bicycle provides medications for opioid use disorder (MOUD), therapy and peer support groups via telemedicine. The provider has raised $83 million in total funding since its inception in 2017.
Research suggests that most patients who use diverted buprenorphine use the drug to manage withdrawals and abstain from other opioids, rather than doing so to get high.
These patients may not be receiving optimal impacts from the drug, according to Bicycle, and not receive wrap-around care like therapy or peer support.
The new study analyzed electronic health record (EHR) data from the first 500 patients consecutively enrolled in Bicycle’s treatment in January 2023, excluding those who were previously disenrolled and re-enrolled in the program.
Of the 500 patients, 232 were already taking buprenorphine when they entered the program, obtained via a prescription or otherwise. Ninety-two patients, or 18.4% of the total group, reported obtaining the drug specifically via diversion.
Researchers attest that these findings validate the need for controlled medication prescribing via telehealth – a capability that may be revoked by the U.S. Drug Enforcement Agency (DEA) in 2025. The DEA may add restrictions to COVID-era flexibilities that allow for prescribing without an in-person visit.
“The DEA intends the in-person visit as a means of limiting buprenorphine diversion,” researchers wrote. “However, this proposal assumes that diversion is uncommon via in-person care and that it is problematic. Our clinical experience is that many patients initiating care with our group are already on buprenorphine and this buprenorphine was obtained via diversion. Our patients sometimes seek telehealth treatment to discontinue use of diverted buprenorphine and obtain a valid prescription.”
In November, the DEA extended telehealth flexibilities through the end of 2025, the third time the organization has extended the deadline.
SUD treatment providers and industry groups have largely lobbied for the flexibilities to be extended or cemented.
“We hope that by expanding access to this life-saving medication via telehealth, we are lowering the amount of diverted buprenorphine while helping more people into safer, longer-term recovery,” Clear said.
