Buprenorphine Mentoring Program Debuts Nationwide

A physician mentoring program promises to help relieve the shortage of U.S. physicians prescribing buprenorphine, a drug the FDA approved in October 2002 for treatment of addiction to opioids, including pain medications and heroin.

FP Martin Doot, M.D., a newly named mentor and medical director of the Advocate Health Care Addiction Treatment Program in Chicago, said buprenorphine is "a remarkable medicine for treating a very difficult patient population. The reputation on the streets is that this stuff works."

In early July, Doot and 44 other practicing physicians received notification of their selection as mentors for the Physician Clinical Support System. Eight of the newly named mentors are FPs.

Mentors have their work cut out for them, said Doot. "There's a lot of misperceptions about this patient population that have to be overcome, and that's where I think a little physician hand-holding is in order," said Doot. "If physicians have a couple of good experiences with patients, then they're usually converts, off on their own and teaching others."

David Fiellin, M.D., associate professor of medicine at Yale University, New Haven, Conn., and chair of the American Society of Addiction Medicine's buprenorphine training subcommittee, said mentors will receive formal training this month and then will provide telephone, e-mail and on-site support to physicians who have completed the required buprenorphine training program.

Fiellin said between 2,500 and 3,000 physicians currently prescribe buprenorphine. While that's almost double the number of those prescribing the drug a year ago, "it's still not enough to meet the need because there are an estimated 3.5 million patients that need this service," he said.

FP Sharon Sweede, M.D., of Asheville, N.C., is past chair of the Academy's Commission on Public Health and the AAFP's representative on the PCSS steering committee. She said her role on the committee is to keep the average family physician's point of view active and present.

"The treatment of addicts is something that family physicians can do very well if we get the necessary training," Sweede said. "In fact, we treat addicts in our practices -- in urban and rural areas across the country -- all the time. We just don't always know it." Knowing how to identify these patients is key to helping them, she noted.

FP mentor James Berry, M.D., of Dover-Foxcroft, Maine, agrees. "I don't know about urban America, but almost every rural area has some addicts," he said. Methadone clinics are usually not accessible to rural communities, he added, saying, "People may have to drive two hours to get their methadone." He said buprenorphine gives people a chance to live their lives, continue their careers and raise their children.

Berry said he was the only prescriber in the northern two-thirds of Maine the first year buprenorphine became available. "Once the word got out, I got hundreds of calls from people. I could only take 30 patients, and the rest of them ended up on a waiting list."

That's because federal law states that a single physician or group of physicians can have no more than 30 patients in opioid addiction treatment with buprenorphine at one time. Bills have been introduced in the U.S. House and Senate to overturn the 30-patient rule.

FP Susan Whitley, M.D., said opioid dependence and heroin addiction are huge problems in her urban practice setting. "A disproportionate number of these folks are in New York City where I practice," she said.

Whitley, a mentor and medical director of a substance abuse treatment program at the Albert Einstein College of Medicine in the Bronx, N.Y., said, "It's important for FPs to start thinking about substance abuse in the same way we think about other chronic medical diseases we treat."

Sam Cullison, M.D., a mentor and director of family medicine education for Swedish Medical Center in Seattle, zeroed in on the need to have more physicians able to prescribe buprenorphine: "The more physicians (there are) willing to do this, the more patients (there will be) who have access to this drug."

The training and certification can be obtained over the Internet for a very low cost, said Cullison. He stressed the impact that FPs can make on patients' lives. "The amount of human tragedy that occurs as a result of (abuse of) substances is monstrous," said Cullison. "Treating patients with addictions is right square in the middle of all the other things we do."