Magazine article Clinical Psychiatry News

Office-Based TX of Opioid Addiction Now Feasible. (Approval of Buprenorphine)

Magazine article Clinical Psychiatry News

Office-Based TX of Opioid Addiction Now Feasible. (Approval of Buprenorphine)

Article excerpt

The approval of the partial opioid agonist buprenorphine for treating opiate dependence has paved the way for office-based treatment of opioid addiction and far greater access to treatment for hundreds of thousands of heroin addicts across the country.

Two sublingual formulations have been approved: Buprenorphine alone, which will be marketed as Subutex and is given during the first few days of treatment under supervision, and a combination of buprenorphine and naloxone. The latter, which will be marketed as Suboxone, is given during the maintenance phase of therapy. Naloxone has been added to deter abuse of the drug, because if tablets are ground up and used intravenously, the naloxone component, which is not well absorbed sublingually, will precipitate withdrawal symptoms.

Buprenorphine is the first narcotic drug for the treatment of opiate dependence that can be prescribed in an office setting. Buprenorphine, administered sublingually, follows methadone and LAAM (l-alpha-acetylmethadol), schedule II drugs that can be dispensed only in special treatment programs, and the opioid antagonist naltrexone, as the fourth approved to treat narcotic addiction.

Subutex and Suboxone are schedule III drugs, which under the Drug Abuse Treatment Act of 2000 can now be prescribed in the office setting by physicians who are specially trained and meet certain requirements. Under this law, medications to treat opiate dependence that are less tightly controlled than schedule II drugs can be prescribed in the office setting, with various checks and balances to deter abuse and illegal diversion of the drug.

"It is hoped that with this new law and the availability of these new drugs, treatment will become available to many more patients," said Dr. Cynthia McCormick, director of the Food and Drug Administration's division of anesthetic, critical care, and addiction drug products, in Rockville, Md. About 70% of the nearly 1 million opiate addicts in the United States do not have access to treatment because there are not enough treatment programs or slots in existing methadone programs. The availability of buprenorphine is not expected to replace methadone therapy.

Buprenorphine is considered to have less risk for causing psychological and/or physical dependence than schedule II drugs, she added. Buprenorphine is not a cure for addiction. Rather, the drug is for symptomatic treatment and has been studied and developed "to be used in the context of greater addiction therapy," which includes psychotherapy counseling, and support, she noted. "The big advantage to buprenorphine is that private doctors who may be treating opiate-addicted patients for HIV hepatitis, diabetes, or hypertension can also be a qualified provider for buprenorphine--so patients can get both treatments from one physician, and that's a huge gain," said Dr. …

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