Volume 4, Issue 3

Introduction to This Issue of The Bridge
By Paul Roman, PhD, University of Georgia
Editor, The Bridge

Buprenorphine and Integration

The theme of the last two issues of The Bridge has been the integration of the treatment of substance use disorders (SUD) into mainstream medical practice, including primary care as well as branches of specialty medicine. This is revolutionary, as it seems that the SUD treatment field has long been on the road of establishing its legitimacy as a distinctive and credible specialty of its own. This transition is however built into the Affordable Care Act, and thus change may be upon the SUD treatment field whether or not it decides to take a hand in guiding this change. Finally, the many dimensions of integration are difficult to grasp or even conceptualize all at once. There is a definite vagueness and a pervasive uncertainty.

One “solid” example of deliberate and aggressive integration was the Drug Addiction Treatment Act of 2000, legislation following the Food and Drug Administration’s approval of the use of buprenorphine for the treatment of opioid dependence. The legislation seemed very much a step ahead of the relatively small world of addiction practice in that it had a distinct mechanism for the involvement of primary care physicians, a group that seemingly contained many who shunned and ignored addiction and its treatment. DATA prescribed that those who took training and obtained a waiver were qualified to use buprenorphine while others could not. To a large degree, the legislation seemed designed to largely keep buprenorphine treatment out of the established and highly controlled system of methadone maintenance, “setting off” the innovative treatment from what had been the paradigm for several decades.

Even though this major change was enacted, it has not been followed by a large body of research to establish what is and what is not happening. We are fortunate to have included in this discussion commentaries by Hannah Knudsen at the University of Kentucky and Dennis McCarty at Oregon Health Sciences University who bring some new data to bear on the many questions surrounding buprenorphine treatment implementation.

The core of this issue is the following interview that I conducted with Dr. Jeffrey Junig, a psychiatrist in private practice in Fond du Lac, WI who has written widely in popular media and specialized blogs about addiction medicine and about the use of buprenorphine. As is seen here, he has a great deal of hands-on experience and is very articulate in considering the many issues surrounding buprenorphine. Dr. Junig holds both Master's and PhD degrees from the University of Rochester's Brain Research Center and his MD from the University of Rochester's School of Medicine and Dentistry, and is a new member of the Editorial Board of The Bridge.

Following the interview are commentaries by nine members of The Bridge’s Editorial Board, including two other new members, Mr. Ron Jackson and Dr. Dennis Daley. We also welcome Dr. Ismene Petrakis of Yale University School of Medicine as a guest contributor.

We invite readers to respond to the ideas presented.To the extent they are appropriate, these reactions may be included in future issues of The Bridge. Please address your comments to Paul Roman at the University of Georgia (proman@uga.edu).

 

The opinions expressed herein are the views of the authors and do not reflect the official position of the Department of Health and Human Services (DHHS), SAMHSA, CSAT or the ATTC Network. No official support or endorsement of DHHS, SAMHSA, or CSAT for the opinions of authors presented in this e-publication is intended or should be inferred.



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