Buprenorphine Offers Alternative to Methadone for Opioid Dependence

Buprenorphine for the Treatment of Opioid Dependence

Boothby L, Doering PL
Am J Health Syst Pharm. 2007;64:266-272

Study Summary

Methadone is frequently used to treat opioid dependence, but it has some limitations: As a Schedule II controlled substance, it can only be prescribed in the hospital setting or at methadone clinics, and it has potential to be abused by patients. This study examined the effectiveness of buprenorphine as a substitute treatment for opioid dependence.

The authors conducted a Medline search of clinical trials involving buprenorphine and buprenorphine-naloxone, both Schedule III controlled substances that can be prescribed by approved physicians in outpatient settings. On the basis of the available literature, they found both buprenorphine and buprenorphine-naloxone to be as effective as methadone, with similar adverse-effect profiles. However, because naloxone's narcotic-antagonistic properties help prevent abuse, they concluded that buprenorphine-naloxone is the preferred treatment for maintenance therapy.

Viewpoint

Treatment for opioid dependence is complex. Due to the restrictions and the potential for abuse that surround methadone treatment, buprenorphine in combination with naloxone appears to be an effective and convenient option.

The Drug Addiction Treatment Act of 2000 (DATA 2000) allows qualified physicians to treat opioid dependence with Schedule III, IV, or V opioids in office-based practices.^[1] Buprenorphine and buprenorphine/naloxone are the first drugs to meet the DATA 2000 criteria. In order for a physician to prescribe these agents for opioid dependence, however, he or she must get a DATA 2000 waiver. Furthermore, compounded versions of buprenorphine cannot be used in these cases.

A patient with an opioid addiction who is admitted to a hospital for a primary medical problem other than the addiction may be administered opioid agonists (eg, methadone, buprenorphine) to prevent opioid withdrawal that would complicate the primary medical problem. In such cases, the prescribing physician does not need a DATA 2000 waiver, nor does the dispensing pharmacist need to verify the physician's authority to prescribe those medications.

However, in the outpatient setting, a physician must be qualified under DATA 2000 to prescribe buprenorphine or buprenorphine-naloxone. All prescriptions for these agents must contain the physician's DEA number. If the prescription does not contain a unique DEA number, the pharmacist must check to make sure that the prescribing physician has a valid waiver by either:

checking the Substance Abuse and Mental Health Services Administration (SAMHSA) online physician locator at www.buprenorphine.samhsa.gov/bwns_locator/index.html; or calling SAMHSA at 1-866-287-2728; or contacting the prescribing physician directly and requesting a fax of his or her DEA registration certificate.

If the physician is not registered, the pharmacist must ask him or her whether he or she has requested a waiver from SAMHSA. The prescription can then be dispensed if the physician has submitted, in good faith, a written application to SAMHSA for permission to dispense controlled narcotics for maintenance or detoxification treatment.^[2]

Abstract

References

Substance Abuse and Mental Health Services Administration. Buprenorphine. Available at: http://buprenorphine.samhsa.gov/ Accessed March 13, 2007. Substance Abuse and Mental Health Services Administration. Frequently asked questions about buprenorphine and the Drug Addiction Treatment Act of 2000 (DATA 2000). Available at: http://buprenorphine.samhsa.gov/faq.html#2 Accessed March 13, 2007.

Jacqueline H. Kostick, PharmD, clinical pharmacist; medical writer/editor, Caremark, Specialty Pharmacy Theracom, Rockville, Maryland

Disclosure: Jacqueline H. Kostick, PharmD, has disclosed that she is employed as a contractor for, and owns stock in, Caremark.

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