Medication-assisted treatment is America's primary offering for those who are addicted. But implicit in the word “treatment” is recovery from an illness or other condition—as in "not suffering from that condition any longer." Is medication-assisted treatment really a recovery-oriented therapy? Or is its primary role preventing a person from relapse and overdose? These are questions those involved in addiction recovery should be asking.
In our interview with Dr. Amerling he expressed concerns about the pharmaceutical industry's dominance over medicine, the limitations of evidence-based medicine, and the use of medication-assisted treatment in addiction medicine. He also criticizes medical schools for compressing basic sciences and promoting arbitrary guidelines over critical thinking. Dr. Amerling advocates for physicians to take back their authority, prioritize patients' lifestyle choices and abstinence in addiction medicine, and to avoid over-reliance on pharmaceuticals.
Globally, the majority of mental health care continues to be provided in psychiatric hospitals, and human rights abuses and coercive practices remain all too common. WHO’s new “Guidance on community mental health services: promoting person-centered and rights-based approaches” further affirms that mental health care must be grounded in a human rights-based approach.
Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy (OBOT) has rapidly expanded in the United States and abroad, and, with this increase in medication availability, there have been increasing concerns about its diversion, misuse and related harms. This narrative review defines the behaviors of diversion and misuse, examines how the pharmacology of buprenorphine alone and in combination with naloxone influence its abuse liability, and describes the epidemiological data on buprenorphine diversion and intravenous misuse, risk factors for its intravenous misuse and the unintended consequences of misuse and diversion.
Buprenorphine is approved in many countries for the treatment of opioid use disorder (OUD), but problems with diversion and abuse exist. There is a need to understand how and why patients use diverted buprenorphine, and whether barriers to access contribute to illicit use.
58% reported a history of diverted buprenorphine use, with 37% never receiving a prescription. Approximately one-half (52%) reported using buprenorphine to get high or alter mood, but few (4%) indicated that it was their drug of choice.
Global consulting leader McKinsey & Company drew unwanted attention in 2020 when a bankruptcy proceeding revealed that it guided the marketing strategy for disgraced opioid seller Purdue Pharma.
Now McKinsey is under scrutiny from Congress after revelations that at least 22 employees who were consulting for Purdue and other opioid producers were also doing work for government agencies tasked with regulating opioid use.
In a July 2019 interview, two faculty of Boston University proposed that buprenorphine start being distributed without a doctor's prescription, with only a pharmacist’s approval. Easier access means that anyone currently struggling with opioid addiction could obtain this drug whenever they chose. But it also means easing restrictions on a drug that is currently abused, sold on the illicit market and addictive. It's time to look at who might profit from their recommendations.