I have never agreed with treating opiate addiction by substituting a legal opiate-like drug such as methadone or burpephenorphine for the illegal drug (e.g., heroin). Mostly what these drug treatment programs do is to maintain the patient in a state of physical dependence on the legal drug methadone or buprenorphine. Too often methadone maintenance programs are underfinanced, understaffed, and overly committed, resulting in the patient remaining in the drug culture and frequently addicted to other drugs and alcohol. I understand the public health argument that these programs can reduce i.v. use, crime, and the spread of AIDS and other STDs, and would favor these programs if the goal were at some point to move the patient to abstinence from all drugs (other than the prescribed drug) and alcohol, and to getting off of the methadone or buprenorphine. I worry about buprenorphine treatment where a physician after completing an eight hour training, will now treat opiate addiction out of his/her office; I wonder what addictions treatment and counseling the patient will receive, in addition to the buprenorphine. I favor comprehesive addictions treatment for opiate addition, with abstinence as the goal, and with 12 Step facilitation therapy (NA and AA).
Jan Williams www.alcoholdrugsos.com