This substantially reported article mostly reviews and updates the politics, marketing and use of opioid medications–notably buprenorphine–in various forms and drug combinations–to treat opioid addiction. The piece is thoroughly researched, containing lots of anecdotes, comments and opinions, including from governors, other politicians, criminologists, a self-described addict, and physicians knowledgeable about addiction and treatment data. But our review team (which includes a primary care physician who educates other physicians on the clinical management of drug and alcohol problems) thought the story relied on relatively unsubstantiated, unpublished claims of safety and efficacy by a company that makes a buprenorphine implant and very little citation of actual published data or expert attribution of information. To its credit, the article hits most of the sticking points involved in the long history of opioid addiction, highlighting that regulations have promoted liberal prescribing of medications that lead to addiction and also inhibit doctors from prescribing medication to treat addiction. It reviews the lack of well-trained doctors, risks of, and restrictions on, prescription “bupes” and the rising prevalence of heroin addiction well beyond urban settings. But the piece could have benefited from stronger reliance on peer-reviewed studies, and much earlier mention of the limitations of the treatments described. And the headline, “Could This Opoid Implant Really End the Opiate Epidemic?” is catchy but overreaching. This primitive hook misleads the reader because the story is about efforts to improve the lives of people suffering with addiction, not waving a magic wand to end an epidemic.
Data from a variety of sources make a good case that addiction to heroin and opioid painkillers is a growing problem in rural and suburban communities, as well as poor urban ones. Partly as a result, efforts to combat the increased rate of lethal overdoses and over-prescription of painkillers are now highly politicized in the presidential campaign season, and beyond the devastating impacts of addiction, voters across the spectrum are looking with intense interest at proposed political action and medical “fixes.” Because the rising numbers of addicts skew heavily younger, and because both BuzzFeed and presidential politics this year are attracting young people in apparently record numbers, articles that document and report on the problem and potential solution are gaining unusual amounts of attention.
Hardly a word is written about costs in any realm of this story: the costs to the economy of lost productivity; the cost of treatments with the “new” implant or any other form of buprenorphine or naltrexone (e.g. doctors need to be trained to do the minor surgical implant, the device and procedure entail cost, etc.); the price and profits involved in the pharmaceutical industry’s painkiller business, or the costs associated with addiction-related treatments, criminal activity and law enforcement. The only real reference is in a quote in which an addiction expert notes that mental health and addiction services “cost money.” Indeed. Big industries; big problems.
An unpublished (apparently) report from a drug maker-sponsored clinical trial — that has data from a three-arm, head-to-head study of opiods (on 176 patients), offers some quantification, although not enough to back the headline contention that this device might possible “end the opioid epidemic.” Results are given in relative terms and are (relatively) modest. There are lots of published studies in the literature that could have been cited to put more reliable data in the article.
The article earns a hesitant Satisfactory rating here. It notes that buprenorphine, including the implanted form, are far from trouble-free, and quotes expert sources making clear that drug therapy is not a “miracle” or an overall effective answer to successful treatment for addiction.
And it lists some specific potential downsides to the implant. For example:
With that being said, the rates of side effects in any study are reported and important, but the story doesn’t discuss them. Any surgical implant has some real rate of negative effects, such as infection, pain/discomfort at the implant site, etc. We wish the story had addressed these issues.
Although addiction treatment research is notoriously underfunded and difficult to do well, there are studies that have produced reliable, or at least credible data and conclusions. These are alluded to, and implied often, in the article, but actual information about such studies is scarce. The article notably mentions that the addict whose personal “life saving” story is told was part of a trial sponsored by the maker of the treatment and also had his travel paid for by the company. But this study at the heart of the story is not clearly described. Details like the duration of the study, whether it was blinded, and its definition of “relapse” — critically important for the management of a chronic disease like addiction — are not provided. The story also draws on numerous interviews with sources that appear to not be involved in research using the implant that is featured in the narrative. The story would have been strengthened by clearer and more transparent attributions, and a bit more background to establish the credentials of those quoted.
BuzzFeed features perspectives from a wide variety of independent commentators. Well done! The story also notes that a pharmaceutical company paid for travel and for the one clinical trial noted in the article.
The story mentions that medication and counseling are the best proven methods to treat addiction and that there are many “dodgy” rehab centers out there that detox patients without offering adequate follow-up. So we’ll rate the story Satisfactory, although we wish that in a story of this length, more of it would have been devoted to studies and results that note the successes/failures of non-opoid treatments (e.g. 12-step programs, psychotherapy, antidepressants, etc.) for addiction, alone on in combination with drug therapy.
The article is clear about the fact that the implant is not currently approved or available, and does a good job of noting the history of efforts to get FDA approval for the implant.
This was a bit of a tough call because it’s hard to fault a piece of journalism that attempts to explain overlapping and complicated approaches to treating drug addiction. The fate of the implant is a news hook of sorts, but it’s premature to say whether it will “end” an epidemic or, like its predecessors, make some situations better and some worse. We’ll give the benefit of the doubt here.
Braeburn issued two releases recently, one on Jan. 12 and one on Feb. 1. The former announced a favorable nod for the implant described in the article by an FDA advisory panel, and the latter a commercialization agreement with another company for the same implant. But the reporter and BuzzFeed clearly went far beyond the release in developing its story, historically and politically.