title: Should the United States Government Repeal Restrictions on Buprenorphine/Naloxone Treatment?
abstract: Attention must be focused on needed changes to the current United States law that restricts physicians who prescribe buprenorphine for the detoxification or treatment of Opioid Use Disorder, to accepting no more than 100 patients. The current system does not provide comprehensive treatment as defined by the American Society of Addiction Medicine (ASAM) criteria. In addition, it suffers from both fragmentation and stigma and will require a significant change to comply with ASAM's call for integrated delivery of comprehensive addiction treatment. This commentary calls for the development and implementation of "best practice," by recommending caution in lifting the 100 patient limit until substantial achievement of this goal occurs. The authors call for an increase to 200 in the patient limit to be restricted to those physicians who are Board Certified in Addiction Medicine by the American Board of Addiction Medicine (ABAM) or in Addiction Psychiatry by the American Board of Psychiatry and Neurology (ABPN), or other responsible medical organizations. Any additional restriction lifting should follow a systemic evolution that rewards and documents competency. Such a system would involve the integration of treatment, treatment systems, and recovery with prescription medication. In addition, it should monitor emotional blunting, treatment progress and initiation of genetic addiction risk testing.
authors.affiliation: a Department of Psychiatry & McKnight Brain Institute , University of Florida College of Medicine , Gainesville , Florida , USA.|b Division of Addiction Services , Dominion Diagnostics, LLC , North Kingstown , Rhode Island , USA.|c Division of Neuroscience-Based Therapy , Summit Estate Recovery Center , Los Gatos , California , USA.|d Departments of Psychiatry & Behavioral Sciences , Keck School of Medicine of USC , Los Angeles , California , USA.|e Division of Neuroscience Research & Addiction Therapy , Shores Treatment & Recovery Center , Port Saint Lucie , Florida , USA.|f Department of Clinical Neurology , PATH Foundation NY , New York , New York , USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Blum
authors.affiliation: d Departments of Psychiatry & Behavioral Sciences , Keck School of Medicine of USC , Los Angeles , California , USA.|e Division of Neuroscience Research & Addiction Therapy , Shores Treatment & Recovery Center , Port Saint Lucie , Florida , USA.|g Department of Psychiatry , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Gold
authors.affiliation: h Public Health Program , Santa Clara University , Santa Clara , California , USA.
authors.forename: H Westley
authors.initials: HW
authors.lastname: Clark
authors.affiliation: f Department of Clinical Neurology , PATH Foundation NY , New York , New York , USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Dushaj
authors.affiliation: i Department of Psychiatry and Neuroimaging , University of Minnesota , Minneapolis , Minnesota , USA.
authors.forename: Rajendra D
authors.initials: RD
authors.lastname: Badgaiyan
mesh_terms: D002047:Buprenorphine; D000069479:Buprenorphine, Naloxone Drug Combination / Q000627:therapeutic use*; D006076:Government; D006801:Humans; D009270:Naloxone; D009292:Narcotic Antagonists; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders; D014481:United States
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine
keywords: Buprenorphine; United States law; competency; drug urine testing; genetic risk; naloxone; restriction cap