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 2004).

"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 Therapies.

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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Hands-On Support

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. Lubran explained.

"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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