Suboxone in the News

By now most of you may have read the New York Times article titled "Addiction Treatment With a Dark Side" highlighting opioid dependence treatment and the use of Suboxone. Several issues I have in regards to the article: Opioid Dependence is a complex chronic disease requiring the skilled utilization of multiple treatment modalities INCLUDING Suboxone. Therefore, physicians should be first educated about the management of this disease BEFORE they start prescribing. An eight hour course is good but simply not enough. Suboxone was NEVER marketed as THE solution for the treatment of opioid dependence. Yes, if used inappropriately or abused , Suboxone can exert adverse side affects INCLUDING accidental overdose. By the way, so do many other medications and OTC products, including Tylenol. Data obtained from the U.S. Centers for Disease Control and Prevention show that more than 300 people die annually as a result of acetaminophen poisoning. Beginning in 2006, according to the CDC, the number of people who died after accidentally taking too much acetaminophen surpassed the number who died from intentionally overdosing to commit suicide. The American Association of Poison Control Centers (AAPCC), a nonprofit that receives federal funds, shows about 113 people dying each year as a result of overdosing on medicines with acetaminophen. Since 2006, acetaminophen has accounted for more fatalities than all other over-the-counter pain relievers combined, according to AAPCC data. Since its introduction in the US market I have repeatedly stressed the point that physicians should be trained and educated about the complex management of opioid dependence and warned about " Suboxone mills" run by unscrupulous physicians in search for a new revenue resources. RB has responded to these warnings and their representatives visited these offices trying to influence the adverse prescription habits of those "physicians". In the article the author questions the addition of Naloxone to Buprenorphine and appears to minimize the abuse potential of generic Buprenorphine. In my daily practice I witness every day attempts by new patients to obtain generic Buprenorphine DESPITE the fact that their insurance will cover Suboxone. Reason: abuse potential, diversion opportunities. In my opinion we need to continue educating physicians about the management and treatment of opioid dependence as a chronic disease and to convince our patients to seek qualified providers of those services. Yes, there are and will be abuses of this medication which has saved the lives of thousands of patients but those pale in comparison with the quality of live gained for so many of my patients. Yours Bernd

Medical Marijuana

I just returned from a speaking engagement in Los Angeles where I also visited Venice Beach. There, I found several "clinics" offering medical evaluation services to obtain a medical marijuana ID Card in order to legally purchase marijuana for medical purposes. At this "Doc in a Box" clinic a licensed California physicians is available for consultation as a medical cannabis specialists. "Patients" should have a documented medical record of diagnosis and treatment or a physician referral. During the exam the physician should document in the patient’s medical record that the patient has a serious medical condition and that the medical use of marijuana is appropriate. Needless to say that the definition of a "serious medical condition" seems to be very flexible and most people lining up at those "clinic" were mostly young, healthy looking and able-bodied applicants. None of those I observed were confined to a wheelchair, using canes or crutches. These clinics will mushroom in each of those states offering medical marijuana treatment solution and will offer legal access to a drug for a vulnerable young population. Are we really that naive to believe that medical marijuana will be confined to those who have serious medical conditions? Yours Bernd