Flawed Comparison Touts Buprenorphine Maintenance

jamaimA new study by Yale School of Medicine suggests that buprenorphine therapy has a higher success rate in treating patients with prescription opioid dependency. Results of the study were published in the Oct. 20 issue of JAMA Internal Medicine, though serious flaws have been noted.

The obvious points left out are that the patients are still chemically dependent on an opioid either way. At least the detox group has some people who are now free from both types of drugs. Additionally, the tapering patients first received buprenorphine for a “stabilization” period that switches their dependence to the new drug.

Dr. David Feillen, professor of internal medicine at the Yale School of Medicine, conducted the study with his colleagues in hopes of giving primary care physicians evidence-based guidelines to decide whether their patients should be provided with detoxification or with ongoing maintenance therapy.

During the 14-week study funded by the National Institute of Drug Abuse, 113 patients with prescription opioid dependence randomly received either buprenorphine tapering detox or ongoing buprenorphine maintenance treatment. The detoxification group received a steady dose of buprenorphine six weeks, followed by three weeks of tapering dosages. All patients in the study received medical support and drug counseling for the duration of the study.

Patients in the detoxification group were more likely to test positive for opioid use than those in the maintenance group. The reason is simple – the latter group was still getting their physical fix from the drug.

According to Fiellen, it is common for patients to ask for detoxification when seeking treatment because they want to be off of all substances as soon as possible. “Unfortunately there is no quick fix for the disease,” Fiellen said.

Despite the agenda to push maintenance drugs, only a small portion of addicts really need to stay on something, if you ask most treatment professionals. Successful long-term rehabilitation programs following the tapering and detoxification period have demonstrated effectiveness, rather than just a bit of counseling and support. Of course there is a time and a place for continuing a medication in this fashion, but most recovery advocates recommend a different form of intervention and treatment first.

Mike Loverde

With firsthand experience with addiction, Mike Loverde is now a Certified Intervention Professional (CIP), as accredited by the Association of Intervention Specialists and the Pennsylvania Certification Board. He founded Family First Intervention in 2008 and has since helped hundreds of families find intervention and addiction rehabilitation solutions.

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