Goodbye detox, hello maintenance

“If the only tool you have is a hammer,
you tend to see every problem as a nail.”
— Abraham Maslow

Perhaps I'm the Wrong Tool by Tall Jerome

There’s a new push to promote buprenorphine maintenance.

If you believe that drug-free recovery is not possible for opiate addicts, headlines like “For Painkiller Addicts, Suboxone Means Freedom, Dependence” and “Prescription Opioid Addiction Can Be Treated with Suboxone, Study Shows” might make sense when you’re reporting on the following study results:

During phase 1, only 6.6% (43 of 653) of patients had successful outcomes, with no difference between standard medical management and standard medical management plus opioid dependence counseling. In contrast, 49.2% (177 of 360) attained successful outcomes in phase 2 during extended buprenorphine-naloxone treatment (week 12), with no difference between counseling conditions. Success rates 8 weeks after completing the buprenorphine-naloxone taper (phase 2, week 24) dropped to 8.6% (31 of 360), again with no counseling difference.

The problem is that doctors know that drug-free recovery is possible. (pdf here) Why are there 2 standards of care?

Also, why was there no additional benefit to counseling? Is there something about buprenorphine that interferes with counseling? Does it de-motivate? Blunt emotions? Or, was it just crappy counseling?

A Dawn Farm position paper on buprenorphine maintenance will be posted soon.

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