- Buprenorphine treatment is more dangerous than other chronic disease treatment.
- Buprenorphine is a replacement addiction.
- Detoxification for opioid use disorder is effective.
- Prescribing buprenorphine is time-consuming and burdensome.
- Reducing opioid prescribing alone will alone reduce overdose deaths.
- Buprenorphine treatment is simpler than many other routine treatments in primary care, for example, insulin titration and starting anticoagulation.
- Addiction is defined as compulsively using a drug despite harm. Taking a prescribed medication to manage a chronic illness does not meet that criterion.
- There is no data showing that detoxification programs are an effective treatment for opioid use disorder. These interventions may increase overdose deaths by eliminating tolerance.
- In office inductions and intensive behavior therapy are not required for effective treatment.
- Despite decreasing opioid prescribing overdose mortality has increased. The noticeable shift to the illicit drug market, where the risk of overdose is higher.
Possible Policy Response
- Amend federal Buprenorphine treatment eligibility requirements during medical school or residency training.
- Competency questions in U.S Medical Licensing Examination.
- A public health campaign to reduce the stigma associated with addiction treatment. An example is the previous HIV campaigns.
- Educate federal and state agencies and policymakers about evidence-based treatment and the lack of short-term detoxification and treatment.Develop disseminate protocols for primary care settings that emphasize out of office induction and treatment.
- Develop a national system of virtual consultation for physicians to reach addiction and pain specialists who can support the treatment of suspected opioid use disorder.
Wakeman, S. E., & Barnett, M. L. (2018). Primary Care and the Opioid-Overdose Crisis — Buprenorphine Myths and Realities. New England Journal of Medicine, 379(1), 1-4. doi:10.1056/nejmp1802741