ASAM president also medical director for drug company

phrma2I missed this a while back. Turns out that ASAM’s president works for a buprenorphine manufacturer.

Stuart Gitlow, M.D., is the president of the American Society of Addiction Medicine (ASAM) and also medical director — as a consultant — for Orexo, which makes Zubsolv, a newly approved buprenorphine-naloxone medication (see ADAW, July 15).

The first public charge of a conflict of interest was made last month via Twitter by Mark Willenbring, M.D., former director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. In the tweet, Willenbring suggested that ASAM should examine its policies about conflicts of interest. While the connection with Orexo doesn’t mean that Gitlow’s beliefs and statements about buprenorphine are incorrect, it does raise questions, said Willenbring, now in private practice in St. Paul, Minnesota, where he provides treatment for substance use disorders and is a strong proponent of medication-assisted treatment. “At the same time, how can someone who is employed by the drug company have any credibility when his financial interest is in selling the drug?” Willenbring told ADAW. “My concern is with the increasing public perception, especially in psychiatry and addiction treatment, that financial interests taint and discredit professional opinions.” Gitlow’s dual roles, said Willenbring, raise this question: “Is he speaking for ASAM as a professional or for the pharmaceutical company as a salesman?”

While I don’t follow ASAM closely, I’ve seen no evidence of Gitlow advocating for any policy that would not receive broad agreement among ASAM membership.

However, as ASAM engages in advocacy around prescribing limits for buprenorphine, is it a conflict that the organization’s president gets a paycheck from a manufacturer?

NAATP launches counteroffensive to medication push

This is very welcome news:

Frustrated that medication-assisted treatment is coming across as the addiction field’s standard of care simply because drug company studies are dominating the research landscape, a group of some of the most prominent leaders in treatment administration is vowing to fight back. These leaders have enlisted the help of another heavy hitter in A. Thomas McLellan, PhD, CEO of the Treatment Research Institute (TRI), to issue a white paper that will highlight the evidence basis for residential, abstinence-based services.

It’s also a little confusing.

Confusing for two reasons. First, I saw McLellan speak at a conference a couple of years ago and he was very enthusiastic about medication as a front line treatment provided in primary care settings.

Second, one of the participating treatment programs was Hazelden. Just yesterday, Hazelden announced its adoption of buprenorphine maintenance.

What prompted this initative? Two things.

First, events at this year’s ASAM conference:

If there was one precipitating event this year that propelled this group into action after much past discussion, Moore says it was the annual conference of the American Society of Addiction Medicine (ASAM) back in the spring. He says that several medical directors at prominent addiction treatment facilities, including his center’s top physician, returned from the conference reporting that the content was completely dominated by pharmaceutical research, particularly related to the opiate maintenance drug buprenorphine.

Second, drug company research is creating pressure from reimbursement sources.

And partly because of the emergence of pharmaceutical research, other sectors of the field appear to be embracing medication-assisted recovery as the first line of defense. In an extreme example, Moore says that in New Jersey, Seabrook House found itself combating managed care policies that were blocking any attempts to place opiate addicts in their late teens into residential treatment, mandating that these young people be seen instead by buprenorphine-prescribing physicians in private practice.