In Brief

In one of its last acts, the 106th Congress passed The Drug Addiction Treatment Act (S. 2634), a bill supported by APA that allows primary-care providers to dispense buprenorphine to patients dependent on heroin and other opiates and recognizes that those who receive the drug should undergo psychological counseling.

Buprenorphine has been found to be a safe and effective alternative to clinical methadone treatment options. Although both drugs are synthetic narcotics that ease withdrawal and curb drug cravings, studies have shown that buprenorphine is a preferred treatment because it has less of a sedative effect. In addition, buprenorphine's dosing is easier for patients: Methadone is taken daily in liquid form, but buprenorphine is ingested as a pill only three times a week.

By allowing primary-care providers to prescribe the drug, the law could minimize the disparity between the estimated 500,000 opiate-dependent individuals currently in need of care and limited treatment slots. Buprenorphine's approval for opiate addiction is in the final stages of FDA review.

The Drug Addiction Treatment Act expands the reach of treatment for opiate addiction in other important ways as well. According to APA Acting Director for Science Policy Geoff Mumford, PhD, "It would offer those who would not seek treatment from methadone clinics for fear of stigmatization--including working people, suburbanites and teen heroin users--a chance to lead a normal life."

Last year as Congress weighed the issue, APA urged that legislation authorizing doctors to distribute buprenorphine from their offices would garner the best results if the medication was administered in conjunction with psychological counseling. Toward this end, APA collaborated with the College on Problems of Drug Dependence, the Academy of Addiction Psychiatry, the American Society of Addiction Medicine and other organizations to lobby the House Commerce Committee. They recommended that:

  • Patients treated for opiate addiction in doctors' offices also receive the proper counseling and psychosocial services vital to their complete recovery.

  • Primary-care physicians undergo more intensive training in the administration of drugs such as buprenorphine.

Although those specific provisions were not included in the final bill, they are consistent with draft guidelines developed by the Advisory Council for the Center for Substance Abuse Treatment within the Substance Abuse and Mental Health Services Administration (SAMHSA) and APA will continue to advocate for those provisions as the SAMHSA rules are finalized. The Drug Addiction Treatment Act heralds "a new era in the treatment of heroin and opioid dependence," says opiate expert Warren Bickel, PhD, vice-chair of the psychiatry department at the University of Vermont and editor of Experimental and Clinical Psychopharmacology.

--E. O'CONNOR