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.