Buprenorphine is one of several prescriptions classified as “medication assisted treatment” for opioid dependence. The term “assisted” specifies that it is to be used in conjunction with a comprehensive addiction recovery program. It is not intended to be used as a “cure” for addiction or as a freestanding medication in the treatment of opioid withdrawal symptoms.
Buprenorphine can be remarkably effective when it is a part of supervised treatment, group and individual counseling, regular testing, and progression in recovery. It is a drug that we use frequently and successfully in our substance use disorder treatment programs at Community Health and Counseling Services and at Wellspring treatment facilities. The medication relieves cravings so that an individual can focus upon building the skills for a successful recovery. It does not “cure” opioid addiction.
In the BDN’s Dec. 30 editorial, “What the Legislature’s drug addiction bill is missing,” addiction specialist Dr. Mark Publicker correctly identifies that Buprenorphine can be used in the treatment of acute withdrawal from opioid addiction. What he does not mention in his outreach to legislators is that it should only be used when there is immediate entry into an ongoing treatment and recovery program.
The initiation of Buprenorphine — known commercially as Suboxone — in hospital emergency departments without confirmation of ongoing treatment is irresponsible and wasteful. Opioid withdrawal can be treated with a number of other medications that do not entail the risk for misuse or diversion and the additional cost that this proposal invites. This proposal is unrealistic in other ways. It adds yet another burden upon hospital emergency departments that will be swamped with patients seeking symptomatic relief but without intention to enter recovery. Hospital emergency departments would become Buprenorphine dispensaries. It is unlikely that emergency room physicians and staff will be willing to obtain the additional certification required for Buprenorphine dispensing to patients who are not enrolled in ongoing treatment.
There is a great need for additional primary care prescribing of Buprenorphine in office-based practices with the necessary resources to support recovery from opioid addiction. Dispensing this medication from emergency rooms will not address the need for an entry portal for people seeking to make a change and to enter into recovery.
The Social Detox Center proposed for the Bangor area provides that portal and in appropriate cases will support referral to primary care based Buprenorphine ongoing treatment. Dispensing the medication in the emergency room will significantly increase costs, increase diversion opportunities, and have no impact upon individuals who, having obtained an expensive medical “Band-Aid,” still will have no place to go to begin their recovery.
Dr. W. Allen Schaffer is chief of psychiatry at Community Health and Counseling Services, attending psychiatrist at Wellspring Substance Abuse and Mental Health Services, and attending psychiatrist at St. Joseph Hospital in Bangor.