Drink and Drugs News DDN November 2018 - Page 8

Buprenorphine TreaTmenT crisis Action is needed now to stop the spiralling costs of buprenorphine, says Roz Gittins W e want to offer high quality, safe, cost-effective services to as many people as we can – that’s why we all go to work in the morning. That’s our passion and our goal. Over the past few months, the spiralling costs of buprenorphine are threatening the vital work of all of us in this sector and more importantly the treatment plans of thousands of clients. Currently, clients are given the choice to decide whether to use medications, mostly methadone or buprenorphine, as part of their treatment for opioid dependency. They make their own decision about their future, based on their own personal needs. They are empowered to steer their own recovery. And let’s not forget, there can be a considerable difference in the effects and patient experience between the two medications. Buprenorphine may be associated with a reduced risk of overdose compared to methadone because it partially blocks other opioids. So if an individual takes heroin on top, they won’t experience the usual effects associated with it, and are usually put off doing so. Buprenorphine can also make people more clear-headed than methadone so may be preferred by some people who are working. Often parents also prefer it because the risks from unintended ingestion are far lower because buprenorphine tablets don’t work if they are swallowed (they should be dissolved under the tongue). Just six months ago, the cost of buprenorphine was about £15 for a month’s supply. Now it’s closer to £130. In one of our services, the prescribing bill for buprenorphine shot up from nearly £3,000 to over £21,000 in just two months. While we’re continuing to support clients prescribed buprenorphine, the long-term sustainability of this will be put in jeopardy if prices remain this high. In normal practice the option of switching from buprenorphine over to methadone would only be considered if clinically appropriate and if the client makes an informed choice to make the change. Transferring someone for cost or supply reasons could generate significant anxiety and have a serious impact on the trust between the client and the provider, which in 8 | drinkanddrugsnews | November 2018 turn could damage their future engagement. Changing to methadone may also destabilise clients or make them feel that they have been ‘put’ on treatment where they have previously ‘failed’. At a time when drug-related deaths are higher than ever before do we really want service providers and commissioners to be forced into that position? The importance of a client’s confidence in their treatment cannot be underestimated. Yet because the cost of this medication increased by more than 700 per cent for some of our services, we have worried clients and frustrated staff, who while knowing the life-saving benefits of buprenorphine are being forced to think about the costs. It’s estimated there are around 30,000 people in England using buprenorphine as part of their recovery plans. That’s 30,000 parents, brothers, sisters, sons, daughters and friends, who are already doing the best they can with their recovery, experiencing extra anxiety. It’s not in our control. It’s not sustainable. It’s not OK. At Addaction, we’re calling for the government to do more. More should be done to monitor the price and supply of this crucial drug within the UK and we want to see adequate contingency mechanisms in place to ensure sudden shortages and price increases do not happen or are quickly dealt with. Roz Gittins is director of pharmacy at Addaction ‘Just six months ago, the cost of buprenorphine was about £15 for a month’s supply. Now it’s closer to £130. In one of our services, the prescribing bill for buprenorphine shot up from nearly £3,000 to over £21,000 in just two months.’