Buprenorphine, a partial agonist at the mu opiate receptor, was approved by the Food and Drug Administration (FDA) for treatment of opiate dependence in 2002.1 Its availability may substantially increase the number of opiate addicts being treated, and may result in superior outcomes.2,3 However, the availability of effective pharmacotherapy for substance abuse is no guarantee of its widespread implementation.4,5 We hypothesized that the majority of internists and family practitioners, who could play a vital role in referring opiate addicts to treatment with buprenorphine (a partial opioid agonist), are not aware of buprenorphine as an option to treat opiate dependence, are unfamiliar with the provisions of the Drug Addiction Treatment Act of 2000 that would enable them to become qualified to prescribe it, and would be unlikely to refer a patient to a qualified physician for this mode of therapy. We believe that this reluctance is based on physician misgivings regarding opiate dependence and associated patient behavior, safety, and lack of insurance coverage for this particular treatment modality. Preliminary data seem to suggest confirmation of these hypotheses and that the strongest independent predictors of referral and prescribing habits of these practitioners are knowledge about buprenorphine, prior experience with pharmacotherapy in substance abuse treatment and an expressed opinion of opiate addiction as a chronic disease, all positive predictors.
Treatment of opiate dependence in hands of primary care providers. Public Health Rep 2003;118:76.
Fiellin DA, Pantalon MV, Pakes JP, et al. Treatment of heroin dependence with buprenorphine in primary care. Am J Drug Alcohol Abuse 2002;28:231-41.
Vignau J, Duhamel A, Catteau J, et al. Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients? J Subst Abuse Treat 2001;21:135-44.
Rosenblum A, Magura S, et al. Ambivalence toward methadone treatment among intravenous drug users. J Psychoactive Drugs 1991;23(1): 21-7.
Rawson RA, McCann MJ, et al. Addiction pharmacotherapy 2000: new options, new challenges. J Psychoactive Drugs 2000;32(4).
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