Buprenorphine offers a way to rise from the ashes of addiction

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Commentary

Buprenorphine offers a way to rise from the ashes of addiction

J Fam Pract. 2021 September;70(7):317

By

Aaron Newcomb, DO

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References

1. Norton BL, Beitin A, Glenn M, et al. Retention in buprenorphine treatment is associated with improved HCV care outcomes. J Subst Abuse Treat. 2017;75:38-42. doi: 10.1016/j.jsat.2017.01.015

2. Evans EA, Zhu Y, Yoo C, et al. Criminal justice outcomes over 5 years after randomization to buprenorphine-naloxone or methadone treatment for opioid use disorder. Addiction. 2019;114:1396-1404. doi: 10.1111/add.14620

3. Mattick RP, Breen C, Kimber J, et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane. Published February 6, 2014. Accessed August 10, 2021. www.cochrane.org/CD002207/ADDICTN_buprenorphine-maintenance-versus-placebo-or-methadone-maintenance-for-opioid-dependence

4. Methadone and buprenorphine reduce risk of death after opioid overdose. National Institutes of Health. Published June 19, 2018. Accessed August 10, 2021. www.nih.gov/news-events/news-releases/methadone-buprenorphine-reduce-risk-death-after-opioid-overdose

5. Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder. Department of Health and Human Services; 2021. Accessed August 10, 2021. www.federalregister.gov/documents/2021/04/28/2021-08961/practice-guidelines-for-the-administration-of-buprenorphine-for-treating-opioid-use-disorder

6. US Department of Health & Human Services. Become a buprenorphine waivered practitioner. SAMHSA. Updated May 14, 2021. Accessed August 10, 2021. www.samhsa.gov/medication-assisted-treatment/become-buprenorphine-waivered-practitioner

7. Buprenorphine waiver notification. SAMHSA. Accessed August 10, 2021. https://buprenorphine.samhsa.gov/forms/select-practitioner-type.php

One of the most rewarding aspects of being a physician is having a direct impact on alleviating patient suffering. On the other hand, one of the more difficult elements is a confrontational patient with unreasonable expectations or inappropriate demands. I have experienced both ends of the spectrum while engaging with patients who have opioid use disorder (OUD).

An untreated patient with OUD might provide an untruthful history, attempt to falsify exam findings, or even become threatening or abusive in an attempt to secure opiate pain medication. Managing a patient with OUD by providing buprenorphine treatment, however, is a completely different experience.

Personally, I’ve found offering buprenorphine treatment to be one of the most rewarding aspects of practicing medicine.

There is no controversy about the effectiveness of buprenorphine treatment for OUD. Patients seeking it are not looking for inappropriate care but rather a treatment that is established as an unequivocal standard with proven results for better treatment outcomes^1-3and reduced mortality.⁴ Personally, I’ve found offering buprenorphine treatment to be one of the most rewarding aspects of practicing medicine. It is a real joy to witness people turn their lives around with meaningful outcomes such as gainful employment, eradication of hepatitis C, reconciliation of broken relationships, resolution of legal troubles, and long-term sobriety. Being a part of lives that are practically resurrected from the ashes of addiction by prescribing medicine is indeed an exceptional experience.

On April 28, 2021, the Department of Health and Human Services provided notice for immediate action allowing for any DEA-licensed provider to obtain an X-waiver to treat 30 active patients without educational prerequisite or certification of behavioral health referral capacity.⁵ The X-waiver requirements were reduced, as outlined by SAMSHA,⁶ to a simple online notice of intent⁷ that can be completed in less than 5 minutes.

I encourage my colleagues to obtain the X-waiver by the simplified process, start prescribing buprenorphine, and be a part of the solution to the opioid epidemic. Of course, there will be struggles and lessons learned, but these can most certainly be eclipsed by a focus on the rewarding experience of restoring wholeness to the lives of many patients.

Aaron Newcomb, DO
Carbondale, IL

Buprenorphine offers a way to rise from the ashes of addiction

References

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