Join Together Online
January 21, 2003
While 616 physicians nationwide are now authorized to prescribe buprenorphine, its widespread use is still an issue, the Baltimore Sun reported on January 15.
Product availability is the first problem. Despite receiving FDA approval in October, the manufacturer did not ship the product to pharmaceutical warehouses until last week.
A more important issue is low interest among primary care physicians. Physicians who do treat addiction say lack of training, concern about having an “unsavory clientele,” and “taking on a complicated sideline that doesn’t pay well” may be reasons why some primary care physicians are not interested.
Without them, there is little chance of treating opiate addiction as a chronic illness. “We need to treat this much more as a health condition and bring this to the general medical world, decreasing the stigma,” said Dr. Peter L. Beilenson, Baltimore health commissioner. But others are confident that the drug will see widespread use once news of its promise spreads.
A third barrier is a federal rule that limits physicians who prescribe buprenorphine to 30 buprenorphine patients per practice. The rule was designed to prevent buprenorphine “mills,” but has stymied institutions such as Johns Hopkins School of Medicine, which is legally considered a single practice.
Dr. Eric Strain, whose research at Johns Hopkins helped get buprenorphine approved, said he doesn’t even know if he will get his license. When asked to certify on his application that he would abide by the 30-patient rule, he refused.
“I wrote in the box that I cannot certify this,” Strain said. “I’m curious to see what happens.”