The recent Herald-Leader article about the failings of buprenorphine in the treatment of opioid addiction is misguided and incomplete to the point of irresponsibility.
To suggest that the drug is equivalent to heroin and is equally detrimental to people suffering from addiction is wrong.
Addiction is a chronic, relapsing and incurable disease. On this, almost all agree. If there were a uniformly successful treatment, we would all be using it. No treatment regimen has shown high rates of success in this complex disease and that includes abstinence-based treatment programs.
Often, our treatment goals are those of risk-reduction to allow patients to live healthier lives, return to the work force, avoid the criminal justice system, and most of all, reduce the risk of overdose death.
Properly monitored patients who are prescribed buprenorphine products are positioned to achieve these goals.
It was particularly misleading to use information of patients' use or abuse of buprenorphine prior to entering a treatment program. This is much less an indictment of the medication and much more a testimonial to the desperation that individuals feel when living with addiction and trying to find a path free.
The article indicated that buprenorphine should not be used in pregnant patients. This is categorically false. Although methadone has been the standard of care for opioid dependent pregnant women, Subutex has been shown to be a safe and effective alternative that may result in a decrease in the incidence and severity of neonatal abstinence syndrome in the infants of mothers on maintenance therapy.
The real issue, as the article mentions, is the prescribing of buprenorphine and the windfall profits being reaped by the providers at the expense of the addict patient. More often than not, the patient is able to have the medication covered by insurance, but the physician refuses to accept the usual and customary payment schedule for service, requiring cash at the time of service.
Providers are allowed to follow 100 patients on buprenorphine. At $300 per patient per month, one provider generates up to $30,000 monthly for perhaps as few as 100 office visits.
Yearly, $360,000 can be generated in cash on the backs of opioid addicted patients while precious few physicians will accept Medicaid payments for this service. As for abuse and diversion, there are limited monitoring resources and state medical boards typically are as interested in the integrity of the medical community as patient safety.
I caution the community in condemning the use of buprenorphine-containing medications in the treatment of opioid addiction. Keeping all options on the table for the treatment of this disease is in everyone's best interest.
And finally, our ultimate goal is to preserve life. We read of heroin deaths every day. One is hard-pressed to identify a single patient who died of a buprenorphine overdose.