BUPRENORPHINE AND METHADONE:

Vastly different requirements - and practices. For methadone treatment of opiate dependence, 6-7 visits each week are mandated for every single patient for several months after treatment begins. For buprenorphine, there are no requirements whatsoever.

According to data presented on Feb. 21, 2008, by the Director of CSAT, SAMHSA, 35% of patients surveyed reported they had NO return visit to the physician for at least 30 days after the very first prescription for buprenorphine was given (no information was provided as to how many returned after the first 30 days). Clearly, this means that during those first 30 days of treatment there was no urinalysis, no assessment of dosage adjustments that might be indicated, no followup of any possible medical or mental co-morbidities, no determining whether "counseling" as needed and, if so, whether it was received and how effective it was, etc. And yet, the Director's presentation also stated that 40% of prescribing physicians believed buprenorphine treatment to be "very effective" for patients receiving treatment for 8-30 days (one must wonder how they knew).

At the very least, the disparities would seem to cry out for a reassessment of the rationale for the extraordinarily onerous and expensive demands that are imposed on patients and providers alike when the medication employed in treating the disease of opiate addiction is methadone rather than buprenorphine.