Our Association has gone on record in supporting the use of “clinically effective and approved pharmacotherapies in a treatment program to ensure a broad range of clinical interventions” through our Association’s Medications Committee. The recommendations of this Committee were published in the September 1997 edition of this News Report and concluded with the view that “no one medication should be used when another may be more clinically effective for the individual patient. The value of new pharmacotherapies is the ability to more effectively treat the patient based on the individual’s needs.”
We are in an era where new medications are being made available to treat chronic opioid dependent individuals and our programs should learn all that we can about the use of these new interventions and add them to our pharmacopoeia. LAAM is the only other currently approved medication in addition to methadone, which can be used to treat chronic opioid dependence in the U.S.. CSAT has published a treatment improvement protocol (LAAM in the Treatment of Opioid Addiction), which provides a valuable resource in guiding treatment programs in how to use LAAM.
LAAM will prove to be a better medication for some patients, who either rapidly metabolize methadone or are not able to attend the program in the normal course of methadone treatment services. Most providers believe that a majority of their patients will prefer methadone, however, we need to use all clinically effective medications, as stated in our policy recommendations.
Buprenorphine is a relatively new medication, which is being evaluated for its clinical efficacy and may be approved for use in treating opiate dependence in the United States. TIME Magazine published an article during January 1998 “A Way Out For Junkies”, describing Buprenorphine as a revolutionary new treatment for opiate dependence, simultaneously denigrating methadone as “a cure nearly as troublesome as the disease it treats”.
We understand that Buprenorphine has been widely used in France in treating more than 40,000 patients and have requested information from our colleagues in France regarding treatment outcome. Dr. Thomas Kosten published findings about Buprenorphine use in research trials during 1993 with his colleagues, titled “Buprenorphine versus Methadone Maintenance For Opioid Dependence”. The abstract indicated that “treatment retention was significantly better on methadone (20 weeks vs. 16 weeks), and methadone patients have significantly more opiate free urine (51% vs. 26%). Abstinence for at least 3 weeks was also more common on methadone than Buprenorphine (65% vs. 27%).”
Our Association’s Medications Committee is developing a policy statement on the use of Buprenorphine while we review research studies on its clinical effectiveness. The ASAM Board of Directors recently issued a policy statement about Buprenorphine use, recommending that general medical practitioners, who have appropriate credentials in addiction medicine, be able to use such medication in the course of normal medical practice. Our committee will publish its recommendations in the next Association News Report, once we have received information from our colleagues in France and other parts of Europe, who have had more experience with this medication.