Should physicians prescribe narcotic substitutes?

 

Further Reading

Dear Mr. Stanton,

I have been adicted to heroine for almost ten years and have spent seven of those on methadone as well. I have only achieved prolonged periods of heroine abstinence twice, eight years ago when I was prescribed Buprenorphine by a Doctor in Los Angeles who treated many individuals I knew in the music industry, and just recently when my clinic started offering LAAM.

I hope to eventually quit using narcotices completely, but after so many years on them and at such a high dose, I have come to accept that discontinuation will take many years (I am seeking counseling as well) and I spent over $7,000 at the clinic last year alone. I am an active and gainfully employed person who would rather not be on a grant even if I was eligible. Do you have any other more affordable suggestions? I believe that low cost treatment should be available to the addict in the form of general or osteopathic physian dispensed narcotics, the clonodine that they are currently prescribing is worthless.

I wish I could find another Physician who would prescribe the schedule V Buprenorphine again here in the Cleveland area, the cost of methadone clinic treatment is a great burden to me and the other is so much more affordable, especially since I can obtain it wholesale from my brother’s pharmacy, if only I had a legitamate script. Any suggestions on how someone might find such a doctor. If the one I knew in LA was still available I would even consider moving back there at this point.

William

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Dear William:

I find your story fascinating, but I have no hard answer to your question: “Can you provide the name of a physician who will provide me with Buprenorphine?”

If I were to summarize your story, it is that you have been addicted to narcotics for much of your adult life, and have found only one usable substitute for heroin. Clonidine and methadone were not successful in weaning you from heroin. Why is it, you wonder, that you cannot have a physician prescribe this in a reasonable way that will make your life manageable?

I leave the pharmacotherapeutics to others. But, clearly, some people for whatever reasons accept one substitute while others do not. You are right—if a physician can negotiate with a patient to provide a workable replacement, why should that not be a matter between the physician and the individual? Indeed, the Swiss have recently instituted a program of providing heroin legally through clinics, and other European countries are experimenting with this approach, which reduces infection, poisoning, and other negative consequences while permitting people to work and live otherwise normal lives.

ON THE OTHER HAND, the physician prescribing maintenance narcotics in the U.S. would face under current circumstances an unbearable liability. And, even if it were permitted, the physician has to face people who play the system, who see the doctor as a ready source for narcotics. In your story, you do not discuss why you want to return to Buprenorphine, now that your clinic provides LAAM, which also seems to succeed for you. Perhaps you prefer LA to Cleveland?

Here’s how I approach addiction therapy: When you think of quitting heroin in LA, what associations do you have in your mind with that period? What has enabled you to quit heroin under your current LAAM regimen? Can you imagine how to bring these elements more to the fore in your life and to guarantee that they will remain stable parts of your existence? What changes can you institute that will do the most to reinforce the changes that have already occurred, or that took place in LA?

My best wishes go out to you,
Stanton