BANGOR (AP) – Maine’s doctors have been slow to embrace a two-year-old drug treatment that can help opiate addicts control their cravings without daily clinic visits, according to a national expert.

About two dozen Maine doctors have taken the eight-hour course required to prescribe buprenorphine, a treatment for opiate addiction that, unlike methadone, does not require daily clinic visits. Instead, doctors can prescribe prescriptions that patients fill at local pharmacies.

A prescription pill would be ideal for drug addicts who live far from methadone clinics or who dread the stigma of daily clinic visits. But only about half of the certified physicians in Maine are treating patients with buprenorphine.

“There is no other part of the country as devastated by narcotic addiction as northern New England,” said Robert Lubran, director of the Division of Pharmacologic Therapies at the Substance Abuse and Mental Health Services Administration in Washington, D.C. “There and in Appalachia. It’s really hard to understand.”

But primary care physicians say addiction treatment is a complicated medical specialty. And, they say, one-day substance abuse and addiction management course that doctors are required to take before prescribing buprenorphine is an inconvenience and does not provide solid clinical grounding.

“On the surface, it doesn’t sound like much of an impediment,” said Gordon Smith, director of the Maine Medical Association. “But I don’t know of any other drug that you need to take a course for.”

Smith said doctors balk at having to take a day away from their busy practices to fulfill the buprenorphine training requirement. In addition, many Maine doctors have all the patients they can handle without opening their doors to the specialized population of narcotics abusers, he said.

“I wish I could say we have a game plan,” Smith said. “Most doctors would agree that buprenorphine should be available, but the barriers are real.”

The issue is a high priority of the MMA’s executive committee, he said.

Expanding the network of physicians able to prescribe buprenorphine is essential to managing Maine’s epidemic of drug addiction, said Kim Johnson, the director of Maine’s Office of Substance Abuse.

“The methadone clinics are all full, and all the buprenorphine doctors can’t take any more patients,” she said. “There is simply no place left to send an opiate addict who needs medication to get control of his disease.”

Johnson’s office has been working to help Mercy Recovery Center and Acadia Hospital in Bangor secure federal and private funding to help create a support system for physicians who choose to treat patients with buprenorphine. There is no state money available.

“I think every physician should be able to do this,” Johnson said. “They wouldn’t have to treat a lot of patients, but they should be able to treat their own patients, like they treat them for other diseases.”

AP-ES-07-11-04 1522EDT



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