WNWY: Dr. Mark Green on Medication-Assisted Treatment

You know there’s a whole set of beliefs that you can’t have a deep recovery when you’re on buprenorphine, and I don’t know what to say about that. You don’t have a deep recovery if you’re dead. Buprenorphine treatment saves lives, is highly effective, reduces illicit drug use, and people who are maintained on buprenorphine for a year are 75 plus percent more likely to abstain from illicit drug use, and people who don’t have closer to zero.

I think that there’s ignorance and stigma. There’s ignorance about the fact that buprenorphine should be prescribed at the dose which is correct for the patient–where their use, cravings, and withdrawal are blocked, and where they are comfortable. And there is no deadline for how long it should be maintained for. A lot of physicians still work from a place where they wrongly think that patients should only be on a low dose for a short amount of time.

There are people who I won’t prescribe buprenorphine for. There are nuances of who I deem might be able to avoid marinated in an opioid for a long period of time. Those are the ones who are not truly opiate dependent. If they are on the edge, I think, great let’s see what we can do. Because when you commit someone to buprenorphine you are marinating them in opiates. If they weren’t opiate dependent beforehand they will be by the time they’re done. So, it’s not something to give to everyone, just like you don’t give every borderline diabetic insulin when they walk in through the door.