New anti-addiction drug slow to catch on in primary care

Physicians say a lack of resources to manage patients who are taking buprenorphine is just one hurdle.

By Victoria Stagg Elliott, AMNews staff. Nov. 3, 2003.

Demand for buprenorphine has been so great in his practice that Gregory Amer, MD, a family physician in Minneapolis, has been forced to turn away patients seeking treatment for their opiate addictions. In the year since a new formulation of the drug made treatment in the primary care setting possible, Dr. Amer has bumped up against the legal limit of 30 patients per physician.

"It's unbelievable. Thirty out of 32 who have asked for the drug have maintained sobriety, are going to their recovery meetings, have made all their appointments, and they're taking it as directed. They say that it's a miracle drug, and their lives have completely turned around," said Dr. Amer, who is also medical director of a local chemical dependency program. "They come here like somebody getting their cholesterol checked or their blood pressure. They just fit right in with routine appointments."

Dr. Amer's integration of the drug treatment into his practice, however, is the exception rather than the rule. When the new formulation gained approval last year, the hope was that buprenorphine would push addiction treatment into primary care. But in reality, it has been slow to catch on in that setting.

A great majority of the doctors listed in the Substance Abuse and Mental Health Services Administration's online database of physicians certified to provide the drug are psychiatrists and addiction specialists. Many of these specialists have prescribed the drug with great success, but anecdotal evidence suggests that the few primary care physicians who have gone through the training required to prescribe it are much more hesitant.