Buprenorphine Update: Mentoring Program Supports Physicians Treating Opioid Addiction
By Julie McDowell
SAMHSA and the American Society of Addiction Medicine
(ASAM) are joining forces through a cooperative agreement
to develop a mentoring program for physicians treating
opioid dependence with the medication buprenorphine.
Funded by a 3-year cooperative agreement grant from
SAMHSA, ASAM—a specialty organization of addiction
medicine physicians—will create a clinical support
system for internists, family medicine specialists, primary
care physicians, pain specialists, psychiatrists, and
other physicians. The system will provide a national
network of 50 trained physician mentors with expertise
in treating dependence on opioids—such as narcotic
pain medications and heroin—with buprenorphine.
"The Agency's goal is to have 6,000 trained and
approved physicians treating patients by the end of 2006,"
said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W.
Currently, 3,558 physicians are certified to prescribe
or dispense the medication; nearly 350 more physicians
have applied, and their notification is under review
at SAMHSA or pending approval.
"The more doctors we have trained to administer
the medication buprenorphine in their offices, the better
off we are," said H. Westley Clark, M.D., J.D.,
M.P.H., Director of SAMHSA's Center for Substance Abuse
Treatment (CSAT). "According to the 2003 National
Survey on Drug Use and Health, non-medical use of prescription
painkillers is on the rise, especially among older adults,
so there's a real need for office-based treatment services
for opioid abuse. There's no stigma attached to going
to the doctor for help."
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DATA and Doctors
Approved by the Food and Drug Administration (FDA)
in 2002 and made available to pharmacies in 2003, buprenorphine
is a medication that allows patients addicted to opioids
to seek treatment in the privacy of their own doctor's
office (see SAMHSA News, March/April
"Our goal is to train as many physicians as possible
in the United States who are able to treat substance
abuse disorders in the many individuals who are dependent
on heroin and prescription pain medications containing
opiates such as oxycodone and meperidine," said
project officer Anton Bizzell, M.D., a medical officer
with SAMHSA's CSAT.
Besides ASAM, mentors in the national network will
include representatives from four other medical specialty
training organizations—the American Academy of
Addiction Psychiatry, the American Psychiatric Association,
the American Osteopathic Association, and the American
Medical Association. These entities are permitted by
law to provide training to physicians on the use of buprenorphine
under the Drug Addiction Treatment Act of 2000 (DATA).
This law allows experts from these organizations—which
are referred to as DATA groups—to provide the required
8 hours of training to physicians to become certified
to prescribe or dispense formulations of buprenorphine.
Some early evaluation work by SAMHSA staff emphasized
the need to encourage more primary care doctors to provide
buprenorphine treatment. This was one of the Agency's
motivations to offer this grant. "We've seen some
reports suggesting that physicians were slow to adopt
this practice, so we thought that one of the approaches
that might help was to bring together addiction treatment
experts with the physicians who are less experienced
in order to bridge that gap," said Robert Lubran,
M.S., M.P.A., Director of CSAT's Division of Pharmacologic
Early buprenorphine evaluations revealed approximately
35 percent of individuals receiving buprenorphine treatment
were first-time patients to substance abuse treatment.
These patients have never tried any type of substance
abuse treatment such as self-help groups or other forms
of medication-assisted treatment for their addiction.
"Nearly 55 percent of patients in the survey were
new to medication-assisted treatment, which shows that
buprenorphine is opening doors in substance abuse treatment,"
said Dr. Bizzell.
"The survey showed that 13 percent of the patients
had been treated previously with methadone prior to buprenorphine
treatment, so we're not disrupting an existing treatment
model," said Mr. Lubran. "People aren't leaving
in droves to go from methadone to buprenorphine. What
we're finding is that these people are new—never
in treatment before. That's a very good sign."
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Under DATA's provisions, SAMHSA has assisted in the
training of more than 5,000 physicians in the use of
buprenorphine. While the 8-hour training is comprehensive
and provides the appropriate amount of information needed
to provide quality care, there are physicians—even
addiction specialists—who feel more confident having
a local colleague with expertise in the care of opioid-dependent
patients and the use of this medication, according to
David A. Fiellin, M.D., an associate professor of medicine
at the Yale University School of Medicine and Chair of
the ASAM Buprenorphine Training Subcommittee.
To provide this support through the ASAM/SAMHSA partnership,
mentors will not only serve as national experts on buprenorphine
treatment, but will also be accessible one-on-one at
the local level for physicians who need additional help
once their training is complete. For instance, during
a training session, the DATA groups may make available
the contact information for these mentors so the physicians
can call on them for "hands-on" support, Mr.
"Physicians who are beginning to provide this
treatment indicate that they would like to receive either
telephone or e-mail contacts. In some cases, they are
invited to observe another physician's practice,"
said Dr. Fiellin. "There, they can see the medication,
meet the patients, and observe some of the procedures
that relate to induction and initiation of treatment
for opioid-dependent patients."
For more information on buprenorphine or to access
the Physician Locator, visit http://buprenorphine.samhsa.gov.
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