Monday, June 20, 2005

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?

5 Comments:

At 3:30 PM, Blogger Me said...

First let me say I agree with everything you are saying. I despise the way methadone is provided in this country and I resent the limitations imposed on buprenorphine prescribing. Righteous anger is a powerful thing but as we well know shaming is not a very effective motivator for change. It doesn't work for addiction and it won't change physician behavior either. Please also keep in mind that physicians like patients are individuals and are just as susceptible to irrational bias. (Evidence based medicine is a relatively new innovation.)The approach I try to take and which I would like to encourage is that while buprenorphine is not better than methadone or a replacement for methadone, it IS an opportunity to begin the discussion afresh. Buprenorphine has the potential to become a fact on the ground so to say and in doing so demonstrate clearly that addiction can be successfully managed as a part of general medical practice without all of the onerous bureaucracy currently imposed on methadone. This can lead to the belated realization that we've been providing methadone wrong all this time. Let us not ourselves be guilty of protecting our turf lest we become no better than those we seek to change.

 
At 3:28 AM, Anonymous Anonymous said...

Hi, I'm writing from Germany. Since two years i get buprenorphine, and im very very happy with it. With methadone i got depressions and i couldnt stand the heroine either. With buprenorphine i go to work, i have a normal life - i wouldnt have this life with methadone...and i'm not the only one...
In France they have just buprnorphine, they dont prescribe metahdone. Sorry, my English is not the best...Greetings from Germany

 
At 12:20 PM, Blogger RGNewman, MD said...

hallo german anonymous - for somne buprenorphine is best, for others methadone, and for yet others "drogenfreie Behandlung." What's important is that for physician and patient there is largest possible "Palette" of interventions. Glad things are working well for you - and by the way, your English is just fine! :-)

 
At 10:51 AM, Anonymous Anonymous said...

Allow me to just point out that methadone IS in fact available and utilized in France. Although buprenorphine has a longer history of wide use, a significant fraction of French patients currently receive methadone.

 
At 8:54 AM, Blogger Richard said...

I am one of the lucky people in the USA that gets to go to the doctor once a month for my prescription of methadone. It took years of trying to get involved with such a program and being a model patient but finally I have the way of life I've always knew was a possiblity. Thanks to all the MM advocates out there who go way beyond their call of duty. Especially the docs from New York, Chicago and Boston. Thanks

 

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