Letter from Norman Anderson on Buprenorphine Treatment

Dear Colleagues,

I am writing you to tell you about an important opportunity for psychologists who are interested in the treatment of substance abuse.

As you know, addiction to heroin and other opioids (e.g., prescription pain relievers) are major public health problems in our nation. For example, data from the Substance Abuse and Mental Health Services Administration's (SAMHSA) 2001 National Household Survey on Drug Abuse indicate that 8.4 million people reported in 2001 that they had used prescription pain relievers for non-medical purposes in the past year. Such abuse contributes to an estimated, $97.7 billion in total economic loss for our society when other non-medical substance abuse is considered.

Furthermore, only an estimated one in four addicted individuals receive treatment for opioid addiction and the number of available treatment slots in traditional methadone maintenance clinics is woefully inadequate. But a new medication, buprenorphine, a new law, and a new way of thinking may provide the means to meet that challenge. And, psychologists have a critical role to play in the provision of relevant treatment services.

Buprenorphine has been under development for over a decade, and many APA members have contributed to our understanding of its psychopharmacologic properties via animal and human laboratory research. Equally important was research demonstrating the importance of combining behavioral and psychosocial interventions with medications in the treatment of opiate dependence. In December of last year, APA Public Policy Office and Practice Directorate staff, with assistance from APA Division 50, organized a review of the Substance Abuse and Mental Health Services Administration (SAMHSA) "Buprenorphine Clinical Treatment Guidelines", setting the stage for a critical science/practice translation activity.

Buprenorphine was approved by the Food and Drug Administration (FDA) for the treatment of opiate dependence last October. It represents an important new treatment option beyond traditional methadone clinics. The combination of Buprenonorphine and the Drug Abuse Treatment Act of 2000 will allow outpatient treatment of opioid addicts in physician's offices. The act also requires physicians who provide buprenorphine treatment to have the ability to refer patients to full-spectrum care for their social and psychological needs. That's where you come in.

Now APA is working with SAMHSA by reaching out to APA members and other psychologists interested in learning about buprenorphine and possible opportunities for patient referrals. SAMHSA has initiated a 14-stop nationwide public education tour entitled, "New Paths to Recovery". The tour will cross the country and return to the East coast concluding in the New York area at the end of May. The full schedule and additional information about buprenorphine is available from SAMHSA.

With increasing recognition of the toll substance abuse is taking on our society, buprenorphine offers yet another opportunity to demonstrate the important contribution that psychologists can make in partnership with our physician colleagues. Collaboration is critical because without effective psychological services, the potential benefit of this new medication cannot be realized. In a recent survey conducted by the APA Practice Directorate and funded by the Center for Substance Abuse Treatment at SAMHSA, 24% of provider psychologists indicated that a client selected from their practice at random had a known or suspected problem related to substance abuse. (Complete details available at PracticeNet.)

If you currently provide substance abuse services, I hope you will consider becoming part of the buprenorphine treatment network. Whether or not you provide substance abuse services, I encourage you to take advantage of some of the many excellent continuing education offerings to enhance your knowledge and skills in providing new and effective psychological treatments in this important area. For those of you questioning your role in the treatment of substance abuse, I'd refer you to a helpful article "Why Psychologists Should Know How to Treat Substance Use Disorders" by Arnold M. Washton, PhD, which has been published in several state psychological association newsletters. 

Norman Anderson, Ph.D.
Chief Executive Officer
American Psychological Association