The National Alliance of Advocates
for Buprenorphine Treatment
Buprenorphine (Suboxone®, Subutex®3, Zubsolv®4, Bunavail™5, Probuphine®6) is an opioid medication used to treat opioid addiction in the privacy of a physician's office.1 Buprenorphine can be dispensed for take-home use, by prescription.1 This, in addition to the pharmacological and safety profile of buprenorphine, makes it an attractive treatment for patients addicted to opioids.2
Breaking the Stereotype
The stereotypical view of a drug user is a morally weak person with no willpower or sense of responsibility, a dishonest self-centered, entitled parasite, worthless to society. This view is expected; the history of addiction outdates political correctness, modern medicine, and an understanding of human physiology. Science has only recently (in last 50 years) begun to understand that some behavioral characteristics are the result of a physical disorder.
Only 40 years ago some people with diabetes were thought to have a psychological deficiency and were institutionalized. Before that, some children who were mentally challenged were thought to be possessed. Studies of the brain revealed that abnormal behavior is often the result of a physical condition. With addiction, poor choices, obsessive behavior, and depression are now known to be the result of physical processes that actually change the brain. What was once thought to be a condition that victims could be talked out of with good advice has now been classified as a medical problem that requires medical treatment. To say that is one thing, but to actually treat it like a disease is another.
The history of addiction outdates political correctness, modern medicine, and an understanding of human physiology.
Stereotypes are hard to break and doctors are trying to treat addiction as the disease they now know it to be. The following is an actual exchange at an addiction treatment physicians’ dinner: One doctor asked, “How many dirty urines (tested positive for drugs) do you allow a patient before you kick them out of treatment?” A few doctors replied with arbitrary numbers, then one doctor replied with “When do you kick out a high blood pressure patient for smoking? Or a high-cholesterol patient for eating cheese?” Until the treating physicians see opioid addiction as a disease, proper treatment will remain scarce. As physicians treat more non-stereotypical people, as more people are saved by the medical treatment of addiction, and as scientists learn more about the physiology of addiction, the stereotype will be diminished.
The first step in breaking the stereotype is to stop perpetuating the negative connotations with the words we use. Words like addict, habit, fix, and abuser reinforce the stigma by creating negative images of the people of whom we speak.
Excerpt from “Substance Use Disorders: A Guide to the Use of Language” by TASC, Inc. under contract for the Center for Substance Abuse Treatment (CSAT) In discussing substance use disorders, words can be powerful when used to inform, clarify, encourage, support, enlighten, and unify. On the other hand, stigmatizing words often discourage, isolate, misinform, shame, and embarrass. Recognizing the power of words, this guide is designed to raise awareness around language and offer alternatives to stigmatizing terminology associated with substance use disorders. It is offered primarily as a resource to those who work within the field of prevention, treatment, and recovery support. See entire document at: Use of language
One of the leading experts in the field of addiction medicine, Dr. Edwin A. Salsitz, realized early on that the language used to describe aspects of addictions contained an inordinate amount of slang and derogatory terms. He points out how damaging it is to the entire disipline of addiction medicine. This is the same terminology developed to prevent people from starting or continuing drug misuse. It paints a very negative image and reinforces the notion that this disease is a choice.
The Following is an excerpt from Dr. Salsitz’s letter:
Dear Faculty and Colleagues,
We have witnessed remarkable progress in the understanding of the disease of addiction over the past two decades. Research into the neurophysiology, psychology, sociology, and various treatment modalities of the disease of addiction, is on a par with any of the other chronic diseases. One of our most important goals is to achieve parity with other specialties in medicine. Indeed, much progress, due to the prodigious efforts of many, has already been made in achieving parity. Our vocabulary in Addiction Medicine is often different from standard medical vocabulary. There has been a tradition of using terms which tend to stigmatize and stereotype our patients and discipline. Many of these terms are slang or "street" language. Although often easily understood and sometimes colorful, they belong in the domain of sociology and ethnography.
We believe that if we adhere to usual medical terminology, it will help our patients and our field of addiction medicine. The organizing committee is asking all faculty to try and limit the "slang" vocabulary. We realize that many of these expressions are deeply imbedded in our field and make for quick communication. We also realize that in certain treatment modalities these terms may be felt to have therapeutic value. Nevertheless, we would like to be the first major conference dealing with the disease of addiction to focus on the vocabulary issue. We also understand that in dealing with a patient, it is necessary to meet them where they are. Obviously, communication in a clinical setting is of paramount importance, and many of these "slang" terms, are necessary for clarity with a patient. But in other areas of medicine, eventually patients learn proper medical terminology from their providers. An example would be diabetes, instead of sugar. Why shouldn't our medical discipline try to instill medical vocabulary, into what we all know is a chronic medical disease.
Salsitz, Miller, Wilford Organizing committee for the ASAM Review Course2002
(read the entire document at: http://naabt.org/documents/ES-lettervoc.pdf )
<< The Birth of a Stereotype | See our page on the use of language: The Words We Choose Matter | Treatment Law >>
The Purpose of Buprenorphine Treatment:
To suppress the debilitating symptoms of cravings and withdrawal, enabling the patient to engage in therapy, counseling and support, so they can implement positive long-term changes in their lives which develops into the new healthy patterns of behavior necessary to achieve sustained addiction remission. - explain -
The National Alliance of Advocates for Buprenorphine Treatment is a non-profit organization charged with the mission to:
- Educate the public about the disease of opioid addiction and the buprenorphine treatment option.
- Help reduce the stigma and discrimination associated with patients with addiction disorders.
- Serve as a conduit connecting patients in need of treatment to buprenorphine treatment providers.
- U.S. Food and Drug Administration, FDA Talk Paper, T0238, October 8, 2002, Subutex and Suboxone approved to treat opiate dependence.
- Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, Md: Substance Abuse and Mental Health Services Administration, 2004.
- Subutex Discontinued in the US market in late 2011.
- Zubsolv (bup/nx sublingual tablet) FDA approved 7/3/2013 see buprenorphine pipeline graphic -in pharmacies now.
- Bunavail (bup/nx bucal film) FDA approved 6/6/2014 see buprenorphine pipeline graphic -in pharmacies now.
- Probuphine FDA approved 5/26/2016 - FDA Probuphine press release