MISCONCEPTIONS AND MISINFORMATION RE METHADONE AND BUPRENORPHINE (click for full article)

An article in the Gazette (Jamesville, Wi, 7 May) is of interest because while its readership may be limited, it epitomizes the misinformation regarding opiate agonist treatment.

The article is based on an interview with Dr. Adedapo Oduwole, “who specializes in addiction psychiatry” and is said to have “headed a pilot program for Suboxone . . . in New York.” Dr. Oduwole’s enthusiasm for buprenorphine is unbridled: he is quoted as saying “…buprenorphine is performing miracles.” Among the more notable misleading and/or incorrect statements:

Methadone “is a substitute narcotic drug . . . “ - with the clear inference that this is a rubric that does not apply to buprenorphine. “With methadone, patients essentially trade one narcotic for another. They go through withdrawal if the supply is interrupted.“ The statement above is followed by: “But buprenorphine squashes [sic!] the opiate craving in a person’s brain. . . “

Buprenorphine “ takes away the craving for the opiate. And it reduces or even eliminates withdrawal symptoms.” The fact that these are precisely the actions attributed for more than 40 years to methadone is not mentioned – leaving the reader to conclude that they are unique to buprenorphine.

The bottom line message is unequivocal: buprenorphine, unlike methadone, is not an opiate, and it is less “addicting” and more effective (by whatever parameters) than methadone.

How to explain such comments attributed to someone who “specializes in addiction psychiatry”? It is perhaps not excessively cynical to consider the possibility that the answer lies, at least in part, in the fact that the doctor is “on an advocate panel for Suboxone through Reckitt-Benckiser, the manufacturer.”

It should be stressed that these critical comments do not in any way imply criticism of buprenorphine as an additional medication in the armamentarium of treatments available to those dependent on opiates who want and need help.