 February 2003 • Volume 9 • Number 2 |
BY SHIRL KASPER
In the North Carolina high country, where patients often drive miles to get to a drug treatment center, FP Sharon Sweede, M.D., anticipates the good that will come from recent FDA approval of the drug buprenorphine. Other medications to treat addiction are available only at drug treatment facilities. Buprenorphine, however, can be prescribed by physicians in their own offices.
"I think it's a good thing for a lot of patients," said Sweede, chair of AAFP's Commission on Public Health. "It will allow patients to live a normal life." With the new sublingual tablets, she explained, patients can go to their local family doctors for treatment rather than drive miles to an addiction clinic.
"When we opened a new (addiction) clinic here in Asheville, we had patients driving in from Tennessee, Virginia, South Carolina and Georgia because there was no methadone clinic in their small town," said Sweede, who works at the Julian F. Keith Alcohol and Drug Abuse Treatment Center in Black Mountain, N.C. "The thing is, buprenorphine is something the patient takes home. Once they get stabilized on it, the doc can give them a whole month's supply."
The FDA approved buprenorphine on Oct. 8 to treat addiction to heroin or other opioids, including prescription painkillers. Buprenorphine, which blocks the craving for drugs, is available from pharmacies now, said Charles O'Keeffe, CEO for Reckitt Benckiser, which markets buprenorphine.
To dispense and prescribe buprenorphine, physicians must complete eight hours of training and obtain a waiver, according to the federal Drug Addiction Treatment Act of 2000.
Web-based training is available, as well as on-site training at national meetings and regional workshops. For workshop locations or to register for Web-based training, go to http://www.buprenorphine.samhsa.gov/training.html. Among organizations offering training are the American Academy of Addiction Psychiatry, American Psychiatric Association and American Society of Addiction Medicine. To request a waiver form or, if you wish, to complete one online, go to http://www.buprenorphine.samhsa.gov/howto.html.
"The thing is, it's so easy for docs to do. They don't actually have to go anywhere," said Sweede, who completed the eight-hour training course when it was offered in conjunction with the ASAM annual meeting. Because Sweede already was ASAM certified, she was not required to take the training but did so anyway.
The Substance Abuse and Mental Health Services Administration, which is leading an initiative to raise awareness about buprenorphine, said more than 2,000 physicians have completed training so far, and more than 300 have received the necessary waivers.
"This major advancement in substance abuse treatment will expand availability of addiction services and permit doctors to treat heroin and other opioid addiction just like any other medical condition, such as diabetes or hypertension," said Charles Curie, SAMHSA administrator.
Estimates vary, but the National Clearinghouse for Alcohol and Drug Information, using 1996 data from the National Household Survey on Drug Abuse, estimated that as many as 2.9 million U.S. residents had used heroin in their lifetime and that about 660,000 had used it in the previous year. Only about 100,000 users were in treatment, the data indicated, in part because of limited access to treatment centers.
"Not everybody on methadone is going to be able to switch to buprenorphine, but a lot of them will," Sweede said. "And a lot of people who have never been on methadone will be able to be stabilized on buprenorphine."
Sweede suggested that FPs even put little signs in their waiting rooms, saying, for example, "Buprenorphine-approved site."
"All the docs have to do is get approved to provide this and give it to one person, and the word will spread," Sweede said. "I bet there are a lot of family doctors out there who have opiate addicts in their practice, and they just don't know it. The addicts are afraid to tell them."
Additional information is online at http://buprenorphine.samhsa.gov/. You can also get further information by calling SAMHSA's Buprenorphine Information Center at (866) 287-2728 or by sending an e-mail request to info@buprenorphine.samhsa.gov.
FP Report is
published by the AAFP News Department.
Copyright © 2003 by American Academy of Family Physicians.