Thursday, January 10, 2008

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the Audacious Ideas blog, of the Open Society Institute-Baltimore, Diana Morris, Director

John Fairhall has embarassed a fine newspaper by producing a series of articles on buprenorphine that is biased, misleading, and sensationalistic. His efforts make the Baltimore Sun look like a cheap tabloid.

Even his self-defense, given in the face of rather blistering criticism, is misleading and/or false. He claims five "undisputed" key findings of his series. They are all wrong or misleading; as such, we dispute them all:

1. "Diversion of buprenorphine is growing." All prescription medications are diverted to unprescribed uses to some degree. Buprenorphine wasn't on the market until recently. Until then, it couldn't be diverted. Now it can, therefore it is, in small amounts. The legitimate question is whether there is a substantial, problematic amount of diversion going on. There is no evidence of a significant problem of buprenorphine diversion in the US. His assertion is misleading.

2. "Buprenorphine is being abused; naloxone hasn't prevented this as much as was hoped." Hoped? We all hope for world peace. Failing to achieve a hope isn't news. Bupe does get abused on occasion, so does Tylenol. So does Ex-Lax. As far as anyone can tell, abuse of Ex-Lax by young women wanting to remain thin is a far bigger problem than what is going on with buprenorphine. Will John Fairhall be producing a three-part expose of Ex-Lax?

3. "Eight hours of training isn't enough." Compared to what? The ZERO hours required for prescribing morphine or cancer chemotherapy agents? The zero hours for performing any particular surgery? Only buprenorphine, among all medications, has a particular training requirement enshrined in federal law. Professional and state regulations guide legitimate practice. The federal training requirement is a peculiar, unique, unnecessary, and excessive requirement. It is eight hours more than enough.

4. "The price of the drug and the associated doctor fees are an obstacle to treatment." The context here is healthcare in America. The price of any and all drugs, and any and all doctor fees, are obstacles to treatment of all diseases. This applies to cancer, heart disease, all mental health problems, everything. There is absolutely nothing unique here in regards to buprenorphine or addiction. His assertion is misleading.

5. "Congress did not take these issues into consideration when it laid the legal foundation for widespread prescribing of bupe." Since "these issues" are false, exaggerated, misleading, or obvious, there's no evidence that Congress failed to take any of them into appropriate consideration.

John Fairhall owes his newspaper, its readers, and his profession an apology, not additional distorted assertions.

Steve Coulter, MD


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