BUPRENORPHINE: Great, but …

Much publicity was given recently to a Senate-sponsored symposium on buprenorphine (e.g., “Senate touts heroin-detox drug,” Aug 4, Detroit Free Press). While it’s great to have another medication available to treat the devastating (and all too often fatal) disease of opiate addiction, there’s no evidence that buprenorphine would or could replace methadone, as much of the coverage suggests. First, some six years after passage of the original law to permit the use of buprenorphine, the estimated unmet need for treatment in America is – very conservatively - about 75% of those in need, the same figure used for decades. Second, the fact that 93% of all patients receiving buprenorphine for opiate dependence are white says a lot about its limited role to date, for whatever constellation of reasons. And yet, the Detroit Free Press quoted unnamed “experts” as saying, “… methadone may still be useful for patients who need pain treatment.” One can only wonder what those experts believe would be “useful” in providing continued life-saving care to the estimated 200,000 patients who, today, receive methadone, let alone to the more than half-million opiate dependent individuals who have no access to any kind of care.