Magazine article Addiction Professional

Testing's Role in Buprenorphine Treatment Programs

Magazine article Addiction Professional

Testing's Role in Buprenorphine Treatment Programs

Article excerpt

Since its introduction in 2002, buprenorphine has proven to be a powerful tool in the treatment of opiate addictions. Buprenorphine curbs the craving for opiates, and can send addictive behaviors into remission. Because of the medication's success, outpatient treatment programs that utilize buprenorphine have been opening at a rapid rate. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the nation currently has more than 11,000 physicians qualified to dispense buprenorphine, and more than 1,800 buprenorphine treatment locations.

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Drug testing is an essential part of the buprenorphine treatment process for a variety of reasons. Most obviously, it is a valuable tool for physicians and clinicians as they gauge program compliance. It demonstrates that the client is taking the medication as prescribed, while refraining from "supplementing" with other drugs or alcohol. This information can be used to benefit both the client and the treatment center: Drug testing can identify a client's need for additional support, while protecting the center's exposure to liability risk through awareness of a patient's possible prescription misuse.

Equally important, drug testing supports the patient's ongoing abstinence. In out former practices as drug and alcohol treatment professionals, we witnessed that clients who receive random drug testing are held accountable for their actions, and thus have more incentive to refrain from substance use. In fact, the observations made in out respective practices motivated us to develop the drug testing protocols currently found in our Vermont-based company, Burlington Laboratories. Clinician Charles Scott Earisman, MA, LCMHC, LADC, notes, "I think that carefully negotiated agreement to use drug testing as part of therapy helps the client feel that their ambivalence is acceptable and understood, and helps the therapist develop a trust in the client. Testing, ultimately, is a tool in developing the therapeutic relationship."

Vital elements

Detailed drug testing can be critical in determining the "big picture" for a client in treatment, offering information about use of other drugs or alcohol. For example, without a specific test for oxycodone, its use may go undetected, as lower doses of oxycodone will not trigger a general opiate positive.

Alcohol metabolite (EtG) testing also has proven to be a critical tool for buprenorphine treatment centers. Where a standard alcohol (ETOH) screen tests only for alcohol currently in the client's system, the EtG test is an indicator that is able to detect alcohol use up to three days post-consumption. In buprenorphine treatment, alcohol testing is vital. Buprenorphine is highly contraindicated with alcohol; the combination can be dangerous. If alcohol use goes undetected, the client is placing himself and the community at risk.

Additionally, studies show that alcohol use during any treatment program can dramatically reduce success rates. From our experience running outpatient programs, we know that invariably there are clients who truly believe that they are able to limit their addiction successfully. They may think, "I'm a heroin addict. I don't have a problem with alcohol." But in our experience, patients who maintain this attitude never completely give themselves over to the abstinence model. They will experiment with "controlled using." This behavior more often than not ends up with the client relapsing back into old using behaviors. …

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