LETTER TO THE EDITOR (NEW: Oct 20'03)
By Robert Newman, MD

TO THE EDITOR:

Two articles in the Aug 13 issue relate to Buprenorphine in the treatment of opiate addiction. Mitka (1) quotes the past president of the Illinois State Medical Society as saying “today’s [heroin] user is more and more likely to be an employed young professional living in the suburbs.” Technically this may be correct, but the fact is that the overwhelming majority of addicts – today just as decades ago – lead lives that are the antithesis of this description. In any event, it seems patronizing to imply that the desire “to be treated in private settings” is a special characteristic (and perhaps right) of employed suburbanites.

Vastag (2) also refers to the stigma of methadone clinics, where attendance means “virtually advertising one’s addiction.” The benefit he correctly ascribes to getting medication from a private doctor’s office, however, where “patients could discretely receive buprenorphine via their regular physician,” ignores the reality that only a tiny segment of the addict population has access to such care; in New York City, for example, one in every four residents has no medical insurance at all, and the ratio is probably far worse for illicit opiate users.

As for the statement by Vastag that it is “easier to withdraw” from Buprenorphine, the challenge in treating opiate addiction has never been achieving abstinence, but maintaining it; there is no evidence to support the notion that Buprenorphine is any more effective in this regard than methadone or the most respected of the drug-free programs. New tools in the struggle to provide clinical help to addicts are always welcome, but raising unwarranted expectations will inevitably lead to disenchantment.

Robert G. Newman, MD, MPH, Director
Baron Edmond de Rothschild Chemical Dependency Institute
Beth Israel Medical Center, NY

555 W. 57th St.
NY NY 10019
Phone: 212-523-8390

1.Mitka M. Office-Based Primary Care Physicians Called on to Treat the "New" Addict. JAMA. 2003;290:735-736
2.Vastag B. In-Office Opiate Treatment "Not a Panacea." JAMA. 2003;290:731-735





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