http://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html?_r=0&smid=pl-share
As many people are aware, Buprenorphine-Naloxone (Suboxone) made national attention in the above article in the New York Times. While there are many accuracies, there are some things that I believe to be misleading. Yes, people have overdosed and died on buprenorphine-naloxone. However, the significant majority of these deaths have occurred when the abuser has taken the medication in combination with benzodiazepines (Xanax, Valium, Ativan, etc.), alcohol, or other abused substances. Clearly, there is an element of harm reduction strategy that is remarkable, especially when deaths from heroin, Fentanyl, and other drugs are considered as the comparison. Furthermore, when using very concrete markers such as (violent) crime (decreased), infectious disease (decreased), employment (increased), the benefits of opiate assisted treatment (e.g. buprenorphine-naloxone) stand out. In reality, when buprenorphine-naloxone is administered and taken appropriately, without these other substances, it is a remarkably safe and effective strategy to deal with opiate use disorders.
When referring to the appropriate administration of buprenorphine-naloxone, it is quite true that many doctors’ practices run counter to this. Unfortunately, many doctors have been quick to take advantage of a very vulnerable (substance use disorder) population by leveraging their license to prescribe buprenorphine-naloxone. Many doctors charge exorbitant amounts of money for this medication, exploiting the very population that needs the treatment the most. These doctors essentially operate medication mills and often do not utilize effective strategies such as pill counts, random drug screens, and treatment contracts.
In sum, while there are many ways one could vilify buprenorphine-naloxone, the treatment, when used appropriately can be a very effective, and often life-changing intervention. The Greenwich Hospital Addiction Recovery Center now offers an integrated buprenorphine-naloxone program that combines medication management with group based treatment targeted for opiate use disorders. The program is state and commercial INSURANCE-BASED making it accessible to the target population that needs this treatment the most. Please call 203.863.4673 with questions. Thanks. Jeremy Barowsky, MD, Director of Addiction Medicine.