A Sept. 9 workshop session on changing times in addiction medicine at the Cape Cod Symposium on Addictive Disorders (CCSAD) served as a ringing endorsement of wider access to medication treatments for opioid dependence. North Carolina physician Don Teater, MD, an 11th-hour replacement for the originally scheduled presenter, stated that methadone and buprenorphine should be a much bigger component of mainstream treatment, even suggesting at one point that buprenorphine should be considered for over-the-counter distribution.
“If you're prescribing opioids, you should be able to prescribe [buprenorphine],” added Teater, who runs the consulting practice Teater Health Solutions and also provides substance use and primary care services for Meridian Behavioral Health Services. He said he primarily works with low-income and uninsured patients.
Teater replaced Cumberland Heights chief medical officer Chapman Sledge, MD, on the CCSAD agenda, and it is likely that he delivered a much different presentation than what would have been offered—given Cumberland Heights' more conservative approach to medication treatments for substance dependence. Comments and questions to Teater during his talk clearly illustrated that many addiction professionals are still wrestling with where medications should fit into the overall menu of services they provide.
Teater, who has prescribed buprenorphine for more than a decade and has worked extensively with methadone, has no such reservations. He termed methadone the most successful treatment strategy for opioid use disorders, although he added that buprenorphine is generally a safer product (referring in part to potential interactions between methadone and other prescribed drugs).
“I've seen people who have failed on buprenorphine succeed on methadone,” Teater said. He added, “Those of us who use it realize it does change lives.”
He said abstinence-based programs for opioid dependence generally have the lowest success rates. He also pointed out that patients can be successfully weaned off maintenance doses of methadone and buprenorphine, although this is a deliberate process.
Teater lamented the lack of available medication-assisted treatment programs in some communities, saying that he recently started helping a patient with a methadone taper because the individual is moving to a state where there are no conveniently located clinics.
Teater also recommends buprenorphine for the treatment of pain, although he said non-waivered physicians generally have shied away from working with it even though it is permitted without a waiver for pain management.
He was not as enthusiastic about injectable naltrexone for opioid dependence, saying it generally has been seen as working better for more narrowly defined populations such as highly motivated professionals. However, he summarized his main message about medication treatments by saying, “All options should be available to everybody.”