Office-based opioid treatment with methadone and Buprenorphine has been implemented slowly due to a combination of policy restrictions and the slow development of a physician workforce.
Despite the fact that Buprenorphine is now available to physicians and restrictions on methadone have been relaxed somewhat, there remain a variety of impediments to having either drug prescribed in an office-based setting. For example:
-For methadone, there remain concerns about its potential abuse and unease with treating one drug dependency with another. And despite recent moves to ease restrictions, current policies continue to ensure that the vast majority of patients with addictionthose who have never received treatment or have relapsedwill have to look outside of mainstream medical care for methadone (Merrill, 2002).
-There are fewer restrictions on prescribing Buprenorphine, but health care providers still face barriers to prescribing it for their patients. Physicians must adhere to ;Buprenorphine-specific licensing and training requirements imposed by the Drug Addiction Treatment Act of 2000, and states have the ability to impose limitations on treatment provided through public funding. The actual availability of methadone and Buprenorphine through private and public treatment systems in different states is an important research question. These restrictions can be difficult and costly to overcome for many physicians, even those who treat HIV patients and who, given the links between opiate abuse and HIV, want to integrate Buprenorphine into their offerings (Schackman et al., 2006).
-Inexperienced primary care physicians may see patients with opioid addiction as demanding, disruptive and manipulative and worry that their practices lack proper access to the mental health services, social services and other support required to effectively provide treatment with either methadone or Buprenorphine (McMurphy et al., 2006). But if offered the opportunity to treat opiate addiction, physicians may be more willing to prescribe Buprenorphine than methadone (Turner et al., 2005).