Buprenorphine Maintenance Therapy Not Recommended

Abstinence-based therapy recommended instead for opioid-addicted health care professionals

THURSDAY, March 8 (HealthDay News) -- Opioid substitution therapy with buprenorphine is not recommended for opioid-addicted health care professionals (HCPs), according to research published in the March issue of the Mayo Clinic Proceedings.

Heather Hamza, C.R.N.A., of the Los Angeles County Medical Center, and Ethan O. Bryson, M.D., of the Mount Sinai Medical Center in New York City, reviewed the literature on buprenorphine maintenance therapy in opioid-addicted HCPs who return to clinical practice after drug addiction treatment. Specifically, the authors reviewed the pharmacology of buprenorphine, its abuse potential and neurocognitive effects, and state-specific recommendations regarding the rehabilitation of opioid-addicted HCPs.

Given the safety-sensitive work that these HCPs perform and the potential consequences of errors, the authors recommend the use of abstinence-based recovery programs until studies demonstrate the safety of using buprenorphine substitution in this population. Most studies evaluating the effects of buprenorphine identified some degree of impairment in higher cerebral functioning. The majority of state programs responding to a survey performed by the authors indicated that they used an abstinence-based model for rehabilitating opioid-addicted HCPs.

"The foundation information required to make good decisions regarding this medication in this population working in safety-sensitive positions is lacking," write the authors of an accompanying editorial. "The use of a medication that has the potential to undermine cognitive function in HCPs working in an emergency or critical patient care setting cannot be supported at this time, given the lack of evidence of efficacy in this population and the absence of adequate national standards for use."

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