UW researcher says there's a simple way to help people addicted to fentanyl

The death toll of the opioid crisis is rising faster in Washington state than anywhere else in the country.

Addiction researchers say one thing that could help would be revisiting federal prescribing guidelines for buprenorphine, one of the main medications that can help people addicted to fentanyl or other opioids by reducing withdrawal symptoms and cravings.

Patients who’ve been using fentanyl need a high dose of buprenorphine to control their symptoms, said Lucinda Grande, a UW School of Medicine professor and primary care doctor who focuses on treating addiction.

“An adequate dose of buprenorphine allows a person to feel normal — like they don’t think about using opiates,” she said. “While if they are on too low a dose, then their mind will constantly go back, ‘I feel a little bit sick; I feel kind of sweaty, chills.’”

Grande is the lead author of a paper arguing that, for patients addicted to fentanyl or other opioids, decades-old FDA guidelines are keeping them from getting an effective dose of buprenorphine. The guidelines don’t mandate what providers can prescribe, but many insurers only cover up to the maximum recommended dose.

Grande said the agency has not yet responded to their research or to a related petition by 10 state chapters of the American Society of Addiction Medicine.

“It’s particularly important in the fentanyl era” to help people struggling with opioid use disorder, she said. “If patients can’t get a high enough dose of buprenorphine and suffer from withdrawal and cravings, they’re more likely to go back to using fentanyl, risking an overdose, and it’s like Russian roulette every day that somebody’s going out and using fentanyl. They don’t know if they’re going to make it through the day.”

Critics of larger buprenorphine prescriptions say they’re concerned patients could share or sell the drug. But Grande said that’s rare — and it’s mainly people sharing with friends who want to stay off fentanyl and who then often seek out treatment.