Handbook of Office-Based Buprenorphine Treatment of Opioid Treatment

At a time when opioid analgesic abuse is our nation's fastest-growing drug problem, and the Centers for Disease Control and Prevention has classified prescription drug abuse as an epidemic (1), the Handbook of Office-Based Buprenorphine Treatment of Opioid Dependence is a must-read for psychiatrists and all other physicians. In addition it has clinical relevance for all nonphysician clinicians involved in treating patients with opioid dependence. Concise, easy to read and clinically useful, this guide clearly addresses the assessment and management of opioid addiction utilizing buprenorphine in psychiatric and primary care settings. It also provides a good overview of nonpharmacologic therapeutic interventions and important resource considerations for the treatment of addiction in office-based practices.

In 2002 the U.S. Congress passed the Drug Addiction Treatment Act of 2000 (DATA 2000), which allows “qualified” physicians to prescribe specifically approved schedule III, IV, or V narcotic medications for the treatment of opioid addiction in general outpatient settings. Sublingual forms of buprenorphine and buprenorphine-naloxone are the only agents currently approved under this legislation, and most physicians qualify for a Drug Enforcement Administration waiver to prescribe them by completing eight hours of formal training. The authors have been coursemasters for many of these trainings and follow in this book the curriculum outline that they often use. As an addiction psychiatrist, I found the handbook to be both a comprehensive and practical clinical resource to guide clinicians in their day-to-day approach to office-based buprenorphine treatment.

Although the handbook exposes the reader to the historical underpinnings that led to DATA 2000 and the safety and efficacy data that led to the Food and Drug Administration's approval of sublingual buprenorphine, most of the chapters focus on patient assessment and management, including detailed approaches to sublingual buprenorphine induction. Comorbid psychiatric and medical considerations are well reviewed, as are practical issues related to preparing one's office to treat opioid-dependent patients. The handbook's review of the current understanding and best practices for special populations, including adolescents and persons with comorbid acute and chronic pain, is outstanding. Although there is some redundancy in material across chapters, this redundancy serves to drive home important points of office-based therapy.

Readers will find that the contributors constitute a who's who of educators in buprenorphine treatment. In addition to chapter summaries, most chapters have bulleted “clinical pearls” that highlight the most important take-home messages. The handbook includes 11 case vignettes with thoughtful questions that illustrate important teaching points and 62 multiple-choice questions and answers. Furthermore, the handbook is full of practical assessment instruments and sample materials that can be adapted for office use.

Some additional prescription drug abuse prevalence data have become available and a new sublingual film preparation of buprenorphine has been approved since the book was written, yet its recommendations and guidance remain on target and relevant. This handbook is an excellent resource for clinicians.