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It's Time For Physicians To Support The Maintenance Model published on 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:

precipitated withdrawal syndrome

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.

precipitated withdrawal syndrome

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?

what's new at

CSAT Director Advises Physicians of Concerns Regarding Buprenorphine In the interest of patient safety and public health, Dr. Clark addresses concerns on Compounding 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 to put themselves on the locator or make any changes to their listing.
AATOD National Conference

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:

in the coming months
• Advocacy
• Pregnancy and Buprenorphine
• Results of Patient Waiting List Pilot
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The National Alliance of Advocates for Buprenorphine Treatment is a non-profit organization formed to help people, in need of treatment, find treatment providers who are willing and able to treat opioid dependency in the privacy of a doctor’s office. Our website offers answers to frequently asked questions, a glossary, actual patient experiences, a discussion board, information on the history and treatments of opioid addiction, current news on the subject and more.

This newsletter is provided to keep you informed on matters relating to Buprenorphine Treatment. Please feel free to contact us at with feedback, suggestions, or perhaps you would like to contribute a story. Also feel free to photocopy or print as many as these newsletters as you wish for distribution.

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The National Alliance of Advocates for Buprenorphine Treatment NAABT, Inc. • P.O. Box 333 • Farmington, CT 06034
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