Veteran's Administration Buprenorphine Criteria

Veteran's Administration (VA)criteria/directive of June 2003 (apparently not modified since) re buprenorphine for opiate dependence. Some highlights:

"In general, methadone should remain the substitution treatment of choice."

"... in the the VA, the limit of 30 patients applies only to individual physicians. There is no limit on the number of patients that can be treated with buprenorphine for group practices."

"The criteria for . . . buprenorphine require that a patient have a documented severe, uncontrollable adverse effect or true hypersensitivity to methadone or LAAM before the physician considers switching to buprenorphine. Patients who are stable on methadone or LAAM maintenance and who do not have a compelling reason to switch therapy should continue maintenance on methadone or LAAM."

Cost paid by the VA system for one month buprenorphine/naloxone tab, 16mg/d, is $176; for methadone, 80 mg = $10/mon if purchased as tablets, $8 if purchased as concentrate