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Physicians With Opioid Dependence—Reply

Physicians With Opioid Dependence—Reply In Reply: I agree with Dr Ward that direct referral to treatment is more desirable than a weekend at home “thinking things over” in some acute situations. However, when direct referral is impractical, careful assessment should be made of potential for self harm and, if safety can be reasonably assured, the physician may be given time to carefully consider the options for treatment and to discuss them with significant others. Regarding possible diversion of prescription medications for profit, it is true that physicians may face legal prosecution when large amounts of medications are found missing. However, I have found diversion for profit to be quite rare among physicians with substance use disorders. Regarding Dr Melcher’s comments, I agree that methadone maintenance therapy is a valuable therapeutic option for patients with opioid dependence. However, the Massachusetts Physician Health Services program has never monitored a physician receiving methadone maintenance therapy. Inquiry through the Federation of State Physician Health Programs listserv resulted in responses from 15 state program directors on this question. Only 4 reported monitoring physicians receiving methadone treatment, and not all of these physicians were actively practicing medicine. While the possibility remains that more physicians are receiving methadone treatment, but not participating in state monitoring programs, I suspect this is not the case. Despite its effectiveness, methadone maintenance therapy is limited by the requirement that methadone can only be dispensed by specially licensed facilities. Buprenorphine, a new replacement therapy for opioid dependence, can be dispensed by pharmacies and therefore has the potential to overcome this limitation.1 References 1. US Department of Health and Human Services. Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Buprenorphine Available at: http://www.buprenorphine.samhsa.gov. Accessed November 4, 2004 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Physicians With Opioid Dependence—Reply

JAMA , Volume 293 (3) – Jan 19, 2005

Physicians With Opioid Dependence—Reply

Abstract

In Reply: I agree with Dr Ward that direct referral to treatment is more desirable than a weekend at home “thinking things over” in some acute situations. However, when direct referral is impractical, careful assessment should be made of potential for self harm and, if safety can be reasonably assured, the physician may be given time to carefully consider the options for treatment and to discuss them with significant others. Regarding possible diversion of prescription medications...
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References (1)

Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.293.3.294-c
Publisher site
See Article on Publisher Site

Abstract

In Reply: I agree with Dr Ward that direct referral to treatment is more desirable than a weekend at home “thinking things over” in some acute situations. However, when direct referral is impractical, careful assessment should be made of potential for self harm and, if safety can be reasonably assured, the physician may be given time to carefully consider the options for treatment and to discuss them with significant others. Regarding possible diversion of prescription medications for profit, it is true that physicians may face legal prosecution when large amounts of medications are found missing. However, I have found diversion for profit to be quite rare among physicians with substance use disorders. Regarding Dr Melcher’s comments, I agree that methadone maintenance therapy is a valuable therapeutic option for patients with opioid dependence. However, the Massachusetts Physician Health Services program has never monitored a physician receiving methadone maintenance therapy. Inquiry through the Federation of State Physician Health Programs listserv resulted in responses from 15 state program directors on this question. Only 4 reported monitoring physicians receiving methadone treatment, and not all of these physicians were actively practicing medicine. While the possibility remains that more physicians are receiving methadone treatment, but not participating in state monitoring programs, I suspect this is not the case. Despite its effectiveness, methadone maintenance therapy is limited by the requirement that methadone can only be dispensed by specially licensed facilities. Buprenorphine, a new replacement therapy for opioid dependence, can be dispensed by pharmacies and therefore has the potential to overcome this limitation.1 References 1. US Department of Health and Human Services. Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Buprenorphine Available at: http://www.buprenorphine.samhsa.gov. Accessed November 4, 2004

Journal

JAMAAmerican Medical Association

Published: Jan 19, 2005

There are no references for this article.