THE BUPRENORPHINE PROMISE:
The Fall, 2007, issue of NYU Physician contains an article concerning research on buprenorphine treatment of addiction that is being carried out by NYU researchers and clinicians. It’s great that the application of buprenorphine continues to be studied. On the other hand, the direct and indirect references to methadone maintenance, more than 40 years after its efficacy was first reported, are terribly distressing. Thus, buprenorphine is said to offer the "unprecedented . . . opportunity [of] readily available [addiction] treatment, in private, with dignity." In other words, the estimated 250,000 hapless patients receiving methadone in the US today are considered (with considerable justification!) to be denied private, dignified care, and for many tens of thousands of others methadone is not available at all - readily or otherwise.
In addition to pursuing the "opportunity" that buprenorphine offers, colleagues at NYU and elsewhere should seek energetically to counter the stigma associated with methadone treatment and what the article states are its "many restrictions that, in a way ... [have] the same panache as being sent to jail." What a horrendous statement - all the more so because it is largely true!
It does not seem overly pessimistic to predict that if the attitudes, regulations and policies governing methadone are not changed, the promise of buprenorphine will never be fulfilled.