Buprenorphine Maintenance Therapy in Opioid-Addicted Health Care Professionals

To the Editor:

In their article entitled “Buprenorphine Maintenance Therapy in Opioid-Addicted Health Care Professionals,”¹ Hamza and Bryson draw a distinction between a “harm reduction and damage control model” of opioid-addiction management and treatment for which abstinence (including, very specifically, abstinence from prescribed agonists) defines both the treatment process and its therapeutic objective. The authors' notion that there is an inherent contradiction between continued prescribing of medication and a patient's “recovery” and the suggestion that reducing harm and controlling damage are not part and parcel of any practice of medicine are extraordinary. The authors accept a role for medications such as buprenorphine and methadone when “used to help retain people in the detoxification phase of treatment” but postulate that “maintenance is another matter and indicates severe difficulty with maintaining recovery.” In fact, the primary challenge faced by health care professionals and recipients of addiction treatment of all kinds is precisely this “difficulty.” In other words, the problem is not the achievement of abstinence but how to maintain it.²

No empirical evidence is presented to support the recommended exclusion from practice, across the board, of health care professionals who are being prescribed buprenorphine. None of the studies cited relied on employment data, malpractice experience, or other measures or proxies of practice competence, and several reported results of buprenorphine administration (some by intravenous injection) among nontolerant individuals. Furthermore, to the extent that there is a basis for concern over individuals receiving maintenance treatment with opioid agonists, it would presumably be vastly greater for those receiving opioids for pain management (acute or chronic) and probably extend to those taking benzodiazepines for insomnia, antidepressants, and a wide variety of other medications.

The efficacy of maintenance treatment of addiction has been confirmed consistently in reports from throughout the world for almost half a century. This treatment has been strongly endorsed by the highest governmental, academic, and clinical authorities in the United States and internationally. It is ironic that health care professionals, of all people, should argue that it should be rejected when it comes to colleagues who want and need the help that it can provide.