Another Option While this article focuses primarily on MMT, it is important to note that some patients will opt for treatment with buprenorphine. Approved in 2002 for patients with opioid addiction, this agent has a reduced potential for euphoria and abuse because of its partial agonist properties.12,15 Another advantage is that primary care providers certified in treatment can administer buprenorphine directly.
The downside of use of this agent is increased cost and lack of access to the counseling services that are such an important component of traditional MMT programs. Because research is limited in the treatment of acute pain for patients who take buprenorphine, more structure and greater caution are called for at times when opioid analgesics must be prescribed.12,13
Conclusion Patients living with opioid addiction experience fear of discrimination, mistrust of health care providers, and often embarrassment and despair over their predicament. Practitioners who suspect opioid addiction should approach these patients with respect but be direct about their concerns and reassuring about the possibilities offered by treatment. An improved understanding of opioid addiction and the benefits of treatment with methadone should enhance management of addicted patients in the primary care setting.
