Treating Addiction to Prescription Opioids.

For over 30 years, medication-assisted treatment for preventing relapse in opiate use disorder has been limited to methadone maintenance and withdrawal treatments followed by naltrexone; however, buprenorphine has emerged as an exciting and successful pharmacotherapy alternative. Buprenorphine is a partial μ-opioid receptor agonist with less abuse potential and a favorable safety profile compared to methadone and offers a great opportunity of office-based opioid addiction treatment (OBOT) to improve patient access. However, we have limited number of providers certified to prescribe buprenorphine in South Dakota. We need to address potential barriers for its expansion, including concerns of diversion and abuse, insufficient knowledge on buprenorphine and addiction treatment, and lack of access to addiction specialists and treatment resources. Since buprenorphine does retain some abuse potential, good office practice needs to be implemented as we expand its access. We need to choose appropriate candidates for OBOT with clear expectations at the intake. We need to enforce urine drug screens, pill counts, and use of prescription monitoring programs. It is also important to provide or refer patients to addiction counseling services and more intensive levels of care including methadone maintenance and residential care when needed.