Buprenorphine has become a mainstay in the outpatient rehabilitation of opioid addiction since it was introduced at Kolmac in 2003. Several years ago, the Hazelden Betty Ford Foundation – the oldest and most respected 12-Step based residential rehabilitation program – broke ranks with its 12-Step treatment brethren by offering its patients the option to take buprenorphine throughout the course of their treatment stay and to continue to do so following discharge. Most similar programs – locked into ideology despite growing evidence of the effectiveness of buprenorphine – still refuse to allow their patients this life-saving opportunity. Their argument is that patients on buprenorphine are not actually in recovery and cannot do the important work of navigating the 12-Steps.
Last week, at the annual meeting of the American Association for the Treatment of Opioid Dependence, I participated in a workshop about the evidence of the effectiveness of the Hazelden Betty Ford approach. Organized by Dr. Robert DuPont, one of the senior leaders in the addiction field, the event was held in the intimidatingly large hotel ballroom seen at the top of this article. The most important conclusion of the Hazelden data was that the patients taking buprenorphine had better outcomes than those who were not offered medications. Furthermore, the buprenorphine did not prevent them from working the 12 Steps.
Important questions still need to be resolved, such as the optimal length of time to remain on buprenorphine. Until formal studies are done, we urge patients to continue to take it until their lives are stable and they have a solid recovery program in place, rather than arbitrarily identifying a specific number of months or years.
A second issue is that some people are so concerned about the difficulty of getting off buprenorphine that they are reluctant to begin taking it. Withdrawal symptoms from all opioids can be extremely uncomfortable. We have already found ways to make the withdrawal from buprenorphine more tolerable and work is continuing to improve this even further.
My hope is that the conflict within the addiction treatment community about the use of buprenorphine will gradually be resolved and the days in which it was denied to patients by treatment programs and denigrated by Narcotics Anonymous will be distant memories. This would allow the current division within the treatment community to return to simpler and less fundamental disagreements, which can be productive.