It's Time For Physicians To Support The Maintenance Model
published on jointogether.org on March 10, 2006
by Jeffrey Baxter, MD
Dr. Jeffrey Baxter supports the Buprenorphine Maintenance Treatment Model and
responds to a comment made by a Boston physician. In an especially effective
analogy, he compares opioid maintenance therapy with insulin maintenance
therapy and highlights the hypocrisy that exists in the treatment community.
He wrote, “What if, after you stabilized your diabetes on insulin, your doctor
insisted that you ‘detox’ off of insulin, or told you that your dependence on
insulin was just covering up your addiction to sugar?”
In response to an unenlightened comment by a Boston physician who stated,
“…Buprenorphine treatment is like giving ‘candy’ to patients with opiate addiction…” Dr. Baxter pointed out the overwhelming body of evidence over
the last 40 years supporting the efficacy of opioid maintenance along with the
statistical evidence of decreases in crime, overdose deaths, and HIV infection
rates. “Calling buprenorphine ‘candy’ for patients with opiate dependence is
likely calling insulin ‘candy’ for patients with diabetes: pure nonsense.” he wrote.
For a physician to conclude that opioid maintenance is not an effective treatment, would require them to ignore years of scientific study and improvements in employment rates, social functioning, and reduced death rates for patients with opiate addiction.
He urges physicians nationwide to abandon their personal biases and support a model of treatment that has been shown to save lives.
He ends with, “Uninformed comments that may keep patients with opiate addiction from receiving effective treatment will cost these patients their lives.”
Read the entire article at:
In October 2002, one day before the FDA approval of Suboxone® and Subutex®, the DEA
rescheduled buprenorphine from a Schedule V to a Schedule III drug. This change was
due, in part, to reports of buprenorphine misuse outside the US. In July 2005, the World
Health Organization (WHO) added buprenorphine to its Model List of Essential Medicines as a “medication that satisfies the priority healthcare needs of the population... with due
regard to the public health relevance, evidence on efficacy and safety, and comparative
cost-effectiveness.” The WHO’s announcement stated, “buprenorphine has been proven
to greatly reduce the risk of HIV infection by reducing drug use and improving the health
and quality of life of opiate-dependent people.” Despite these favorable remarks, early this
year the WHO decided to reevaluate the classification of buprenorphine and entertain
restricting it further. A proposed change in the way buprenorphine is listed internationally
could result in a rescheduling in the United States.
Due to the continuing success of office-based treatment with buprenorphine,
there was strong opposition from leading physicians and professional health organizations,
including the APA, that stated, in response to this potential change that it could have a “chilling effect on access to buprenorphine…” They warned that the change could
influence the DEA and if buprenorphine were rescheduled to a Schedule II, in the US, it
would lead to the elimination of office-based buprenorphine therapy for opioid addiction.
Based on this input and extensive similar opposition, on March 31, 2006, the
WHO committee decided not to make any recommendation for changing the current
scheduling of buprenorphine. They cited further limitations would have negative effects on
availability of buprenorphine which contributes to the efficient prevention and treatment
of HIV/AIDS among opioid dependent injecting drug users. Buprenorphine will remain a
Schedule III drug for the time being.
NAABT has completed the small-scale pilot program of the National Patient Waiting List.
It has shown to be an effective tool in efficiently connecting patient to physician.
Example: A patient sought help late on a Sunday night by registering on the site. The
next morning he was contacted by a physician and was induced the following day.
We believe the 24/7 access will allow a patient to reach out whenever and as
soon as they are ready to seek treatment. The online list has shown to be a nonintimidating
way for patients to proactively seek help. The next step is a multi-city and
statewide test that will transition into multi-state then nationwide.
See: What is the
NAABT National Patient Waiting List? http://naabt.org/patient_doctor/waiting_list.cfm
CSAT Director Advises Physicians of
Concerns Regarding Buprenorphine
In the interest of patient safety and public
health, Dr. Clark addresses concerns on
and Selling Buprenorphine.
Preliminary Findings from SAMHSA/
CSAT’s Evaluation of the Buprenorphine
Waiver Program can be found here.
CSAT released a revised “notification of
intent”. The new version does not reuire
a physician to include a list of all other
physicians in his/her group practice.
|CSAT and NAABT are asking all certified
physicians who are not on the SAMHSA
locator to please reconsider their
participation. Waived physicians may call
1-866-BUP-CSAT (1-866-287-2728) or
e-mail email@example.com to put themselves on the locator or
make any changes to their listing.
April 22 - 26, 2006, in Atlanta, Georgia.
The theme for this year’s conference is
“TREATING PEOPLE WITH DIGNITY:
Working with Criminal Justice and
Health Care Systems”.
Included among the activities are
numerous workshops, exhibits, hospitality
activities and entertainment as well as
local facility tours. As always, Saturday and
Sunday will feature a series of cutting
edge pre-conference sessions for veteran
clinicians, clinicians new to the field and
all other conference participants.
For comprehensive information,
please go to:
• Pregnancy and Buprenorphine
• Results of Patient Waiting List Pilot
|All NAABT literature is available on the
naabt.org Literature page as PDF files
of literature for you to download and
view or print for your convenience. For multiple copies of NAABT
Literature, please email your request
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