MMS Promotes Physician Education on Office-Based Addiction Treatment

In December 2002, the Substance Abuse and Mental Health Services Administration (SAMHSA) launched an education initiative to raise awareness about buprenorphine, a new medication to treat opioid addiction that can be prescribed at the office rather than at a specialized addictions clinic.

"Heroin use is on the rise, the abuse of prescription medications has surged, and misuse of prescription medications -- particularly among young people -- gives particular reason for pause," said Westley Clark, M.D., J.D., MPH, CAS, FASAM, director of the Center for Substance Abuse Treatment at SAMHSA. The 2001 National Household Survey on Drug Abuse found that 12 percent of youths aged 12 to 17 (almost 3 million children) and almost 23 percent of young adults aged 18 to 25 (nearly 7 million) had used prescription-type drugs nonmedically at least once in their lives.

Buprenorphine can be used to treat addiction to heroin, as well as other opiates. Opiates other than heroin -- including nonprescription methadone, codeine, Dilaudid, morphine, Demerol, opium, oxycodone, and any other drug with morphine-like effects -- may be abused, resulting in addiction or dependency. According to SAMHSA's Treatment Episode Data Set, opiates other than heroin accounted for 10 percent of opiate admissions in the United States in 2000.

"The approval of buprenorphine for opioid treatment in the physician's office is an important development," said Luis Sanchez, M.D., director of Physician Health Services. "For many people -- people dependent on painkillers, professional people worried about their jobs -- a methadone clinic may not be the treatment of choice."

According to SAMHSA, in 2000, Massachusetts had an estimated 108,000 people aged 12 or older needing, but not receiving, treatment for an illicit drug problem, making this state fourth in the nation as a percentage of the population.

"We need a network of physicians qualified to treat with this new medication," said Dr. Sanchez. Currently, only 56 physicians in Massachusetts are licensed to prescribe buprenorphine; of those, only 30 are currently accepting patients.

In order to prescribe buprenorphine, physicians must attend an eight-hour training session and obtain certification through SAMHSA. In an effort to increase access to addiction treatment, the MMS and Boston Medical Center will sponsor a CME course on buprenorphine and office-based treatment of opioid dependence. The program will take place November 22 at the MMS headquarters in Waltham and will provide an overview of opioid dependence. It will also discuss how to assess whether a patient is appropriate for office-based treatment and provide information about the pharmacology, efficacy and safety of buprenorphine.

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