Intended for healthcare professionals

Observations Letter from New England

No mission without the marginalized: the scope of family medicine

BMJ 2014; 348 doi: (Published 26 February 2014) Cite this as: BMJ 2014;348:g1707

Re: No mission without the marginalized: the scope of family medicine

Dr Loxtercamp's plea for compassionate treatment of addicts is laudable, but many of the points he makes are unique to the USA and are not evidence based. The evidence base for methadone in opioid substitution therapy (ORT) is greater than for buprenorphine, but he is presumably unable to prescribe that because of US regulations restricting it to designated clinics. He is making a big mistake in time limiting his treatment with buprenorphine to two years. The evidence is overwhelming that with ORT there should be an orientation to maintenance and that any artificial time limits on treatment are only likely to lead to a rapid relapse to illicit use.

Reference. BMA Board of Science (2013). Drugs of Dependence: The Role of Medical Professionals. 8.4.4.

Competing interests: I prescribe methadone or buprenorphine to many patients. I have given many talks on opioid substitution therapy and have received travel grants and honoraria from manufactures of both.

06 March 2014
Richard Watson
General practitioner and RCGP Scotland Clinical Lead Substance Misuse
Craigallian Medical Centre
11 Craigallian Avenue, Glasgow, G72 8RW