What The US Can Learn From France's Handling Of The Opioid Crisis

By Beth Leipholtz 04/17/18

The French increased access to buprenorphine and overdose deaths dropped 79% over four years. Will the US follow suit?

French and American flag

Despite the recent focus on the country, the United States isn’t the only nation to have faced an opioid epidemic. 

According to The Atlantic, France also contended with a serious heroin epidemic in the 1980s, with overdose fatalities rising 10% each year. Despite the climbing overdose deaths, the minimal treatment options consisted of counseling at substance abuse clinics. 

But in the 1990s, that began to change. The Atlantic reports that in 1995, France changed its regulations around buprenorphine, a medication that reduces opioid cravings. The new regulations made it so that in France, any doctor could prescribe the medication, even without licensing or training. 

The next four years in France saw a decline of 79% in overdose deaths. The Atlantic states that this was due to the fact that 10 times as many people struggling with opioid use were able to receive medication-assisted treatment since all primary care doctors were able to prescribe buprenorphine. 

Other factors in France may have come into play, however.

"France has a socialized medical system in which many users don’t have to worry about cost, and the country also developed a syringe-exchange program around the same time," The Atlantic reports. “Some of the users did sell or inject the buprenorphine (as opposed to taking it orally, as indicated), though these practices didn’t result in nearly as many deaths as heroin does.”

In countries including the United States, the regulations around buprenorphine prescriptions are tighter. According to The Atlantic, in the U.S., a doctor must take an eight-hour class before they can prescribe the medication. This can deter doctors because it costs money and is another commitment on top of their busy schedules.

The U.S. is taking baby steps to increase access to the medication. Earlier this year, the Department of Justice issued a deregulatory measure which allows nurse practitioners and physician assistants to prescribe buprenorphine. 

Andrew Kolodny, a psychiatrist who studies addiction at Brandeis University, tells The Atlantic that another obstacle may be that doctors are unsure about working with patients who struggle with substance use. Some studies also back up this idea. 

Yet another complication lies in the fact that in the United States, Medicaid will cover a decent amount of treatment, but often Medicaid programs have parameters concerning buprenorphine.

Keith Humphreys, Stanford University professor of psychiatry, told The Atlantic via email that doctors are hesitant to treat those with substance use disorders for fear that it will affect their other patients. 

“Doctors also want to take care of kids with colds, and adults with bad backs and cancer patients and the panoply of humanity that they know how to take care of,” he said via email. 

In order to determine how difficult it would be to find a doctor to prescribe buprenorphine in the U.S., The Atlantic conducted a small experiment that led to discouraging results. 

The Atlantic looked up Parkersburg, a city of 30,000 people in West Virginia, the state with the most overdose deaths, on Suboxone.com, a site that lists buprenorphine providers,” the article stated. “We found 10 doctors within a 50-mile radius who prescribe buprenorphine, and we attempted to reach all 10.”

Of these, The Atlantic found that one doctor had a waiting list, three did not accept any insurance and one was unreachable. Only one doctor was accepting new patients and also accepted insurance. 

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Beth is a Minnesota girl who got sober at age 20. By day she is a website designer, and in her spare time she enjoys writing about recovery at www.lifetobecontinued.com, doing graphic design and spending time with her boyfriend and three dogs. Find Beth on LinkedInInstagram and Twitter.