Opioid addiction can be treated in docs' offices

By Megan Rauscher

NEW YORK (Reuters Health) - People addicted to opioids, such as certain prescription painkillers and heroin, can be conveniently and effectively treated in their primary care doctor's office rather than in a special clinic, researchers from Massachusetts report.

Specialized clinic-based treatment programs, which have long been used to treat opioid dependence, reach only a fraction of those in need. With office-based treatment, greater numbers of addicts are likely to receive needed treatment to kick their dependence on opioids, the researchers predict.

Opioid addicts who are "ready to make changes in their lives and become drug-free should be encouraged to seek treatment with their primary care provider," Dr. Ira L. Mintzer from Harvard Medical School and the Cambridge Health Alliance told Reuters Health.

In 2002, the US government loosened regulations on opioid treatment by allowing primary care doctors to offer opioid treatment using a combination of buprenorphine and naloxone, which effectively curb drug cravings.

Mintzer and colleagues evaluated a series of 99 opioid addicts receiving buprenorphine-naloxone treatment at two city primary care doctor's offices. No subject was younger than 20 and only 10 percent were older than 49. The patients' principle drugs of abuse were heroin, illicit methadone, or prescription OxyContin.

Based on regular urine testing, physical exams and interviews, more than half of the patients (54 percent) were off opioid drugs at 6 months. This success rate is "comparable to patients receiving methadone maintenance for opioid addiction and requires fewer resources than are provided in methadone clinics," Mintzer said.

Predictors of success included attending self-help meetings such as Narcotics Anonymous, having a job, having private health insurance, and older age.

Based on the findings, Mintzer believes greater numbers of patients should have access to buprenorphine-naloxone treatment in nonspecialized settings by doctors with "some training and interest in addiction medicine."

Of the three general internists providing opioid treatment, one was a certified addiction specialist while the other two received a day-long training course in buprenorphine-naloxone treatment, as required by law.

Many people who are dependent on opioids would seek treatment if they knew it, the team believes. "Awareness of the availability of buprenorphine-naloxone treatment spread quickly by word of mouth, resulting in demand for treatment that exceeded the legal limit of 30 patients per site," they report.

SOURCE: Annals of Family Medicine, March/April, 2007.