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Goodbye detox, hello maintenance

Posted Nov 10 2011 7:59am
“If the only tool you have is a hammer,
you tend to see every problem as a nail.”
— Abraham Maslow

Perhaps I'm the Wrong Tool by Tall Jerome

There’s a new push to promote buprenorphine maintenance.

If you believe that drug-free recovery is not possible for opiate addicts, headlines like “ For Painkiller Addicts, Suboxone Means Freedom, Dependence ” and “ Prescription Opioid Addiction Can Be Treated with Suboxone, Study Shows ” might make sense when you’re reporting on the following study results :

During phase 1, only 6.6% (43 of 653) of patients had successful outcomes, with no difference between standard medical management and standard medical management plus opioid dependence counseling. In contrast, 49.2% (177 of 360) attained successful outcomes in phase 2 during extended buprenorphine-naloxone treatment (week 12), with no difference between counseling conditions. Success rates 8 weeks after completing the buprenorphine-naloxone taper (phase 2, week 24) dropped to 8.6% (31 of 360), again with no counseling difference.

The problem is that doctors know that drug-free recovery is possible . (pdf here ) Why are there 2 standards of care?

Also, why was there no additional benefit to counseling? Is there something about buprenorphine that interferes with counseling? Does it de-motivate? Blunt emotions? Or, was it just crappy counseling?

A Dawn Farm position paper on buprenorphine maintenance will be posted soon.

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