Buprenorphine Use In the US

The First Three Years of Buprenorphine in the United States: Experience to Date and Future Directions.

Review Article, Journal of Addiction Medicine. 1(2):62-67, June 2007. Fiellin, David A. MD

Abstract: Buprenorphine, primarily as the buprenorphine/naloxone combination, has been available in the United States for office and specialty treatment program-based care since 2003. The existing evidence, collected primarily from federal sources, indicates that access to this type of treatment has expanded, that more than 50% of the 12,000 physicians able to provide this care are not addiction specialists, that buprenorphine diversion is low, that physician scrutiny by federal agents is infrequent, and among those receiving treatment patient acceptance is high. Implementation has been slowed because of physician training and support needs, reimbursement, and limits on the number of patients each physician can treat. As a result there are geographic variations in access and unmet treatment needs. The United States Congress has moved twice to loosen numerical limitations, now allowing each physician to treat up to 100 patients. Future research and evaluation are needed to ensure that opioid-dependent patients receive optimal care with buprenorphine.

(C) 2007 American Society of Addiction Medicine

Buprenorphine: The Basic Pharmacology Revisited.

Invited Review
Journal of Addiction Medicine. 1(2):68-72, June 2007.
Cowan, Alan PhD

Abstract:
The historical background leading to the current use of buprenorphine as an analgesic and its role in the management of opioid dependence is summarized. The popular description of buprenorphine as a "partial agonist" is discussed in relation to efficacy in animal models of antinociception and clinical analgesia. The latest information on the respiratory depressant effects of buprenorphine and its N-dealkylated metabolite (norbuprenorphine) is presented. New data on the buprenorphine withdrawal syndrome in rats are described.

(C) 2007 American Society of Addiction Medicine