Clinical Guidelines and Procedures for the use of Buprenorphine in the Treatment
of Heroin Dependence
The National Clinical Guidelines and Procedures is targeted at prescribers
and dispensers of buprenorphine, especially general practitioners working
in the area who have some familiarity and experience in treating heroin dependence.
The guidelines cover both the maintenance and withdrawal programs using buprenorphine.
Reference: This document has been prepared by the Intergovernmental
Committee on Drugs (IGCD) sub-committee, Methadone and Other Treatments—AUSTRALIA.
Published by AusInfo for Commonwealth Department of Health and Aged Care
June 2001 (The document is available in PDF format and requires Acrobat Reader
which is a free software)
Using Buprenorphine for Office-Based Treatment of Opiate Addiction in the
United States
United States: Recommendations to the Center for Substance Abuse Treatment
(CSAT) of SAMSHA - Drafted by the Council's Subcommittee on Buprenorphine
(Sept. 15, 1999)
Overall Conclusions
- The research base on buprenorphine supports the feasibility, effectiveness,
and safety of providing partial agonist treatment in office-based settings.
As clinical use of buprenorphine for opioid addiction treatment is introduced
in the United States, additional information should be gathered and carefully
assessed...
- Office-based buprenorphine treatment is desirable, since it can help
to promote the shifting of opioid treatment into mainstream medicine and
expand access to opioid treatment services.
- While complying with the Controlled Substances Act (CSA), CSAT 's regulations
for buprenorphine treatment should follow the usual procedures and standards
used in treating any medical condition and should be kept as limited and
non-restrictive as possible.
- CSAT should work with the Drug Enforcement Administration (DEA), the
Food and Drug Administration (FDA), and the States to coordinate, streamline,
and hopefully to simplify the requirements that must be met by individual
practitioners.
- The new Federal regulations should allow for flexibility, provide protection
against the premature "freezing" of regulatory requirements,
and allow for incorporation of new knowledge based on expanding practice
experience.
- A reasonable continuum of care should be sought for all buprenorphine
patients.
- Detailed practice guidelines should be developed and used to provide
basic guidance for practitioners, including criteria for patient admission
and discharge.
- A system of practitioner selection, certification, and training will
be needed to provide basic standards regarding knowledge and practice.
Initially, CSAT may want to consider a system that incorporates only physicians
who have demonstrable experience in addiction medicine, then later phasing
in additional practitioners over time.
- New structural models of service delivery, including links to specific
pharmacies, need to be developed, tested and then promoted with States,
regions, counties and communities.
- New buprenorphine guidelines should allow for buprenorphine treatment
practices in traditional methadone clinics, as well as in individual and
group medical practices.
Other Resources
- Substitution Treatment with Buprenorphine (France)(read
more)
- Preliminary Observations in Substitution Treatment of Opioid Dependence
(read more)
- Two-year follow-up of an opioid-user cohort treated with high-dose buprenorphine
(Subutex®) (read more)
