ATTRACTIVENESS OF BUPRENORPHINE V. METHADONE TREATMENT

Previous blogs have referred to a Twin Cities news article on the attractiveness of buprenorphine as a medication for opiate addiction treatment. That article refers to a hypothetical "suburban housewife” who places a methadone program last on her list of providers of choice. But that's not only true of the stereotypical "suburban housewife"! The regulations imposed on methadone programs, and the common (but not universal) attitudes of staff and the community at large, make many of them awful places to seek health care. Patients are forever subject to “urine controls” (in most programs, under direct observation), always having to ask permission to go on vacations, dealing with child welfare bureaucrats who view appropriately prescribed methadone as no less an evil than street heroin – and equal grounds for denying custody, etc. What’s amazing is that a couple of hundred thousand American opiate dependent individuals are so desperately motivated for help that they seek and enter such programs notwithstanding the rules, patronization, stigma, etc. Also amazing - and distressing - is that so few physicians are willing to take the minimal steps needed to gain authorization to prescribe buprenorphine to those patients who need and want it.

The fundamental question is why addiction is not treated – and treatable – like all other chronic illnesses. Why limit methadone to "comprehensive treatment programs"? We don’t we demand “community approval” to open a radiology imaging center, or a sexual health practice where Viagra is prescribed, or a facility that treats Downs syndrome children and offers support to their parents, or smoking cessation programs or facilities where AA holds its meetings. For buprenorphine, why demand special training? Why patient limits?