Thanks for your reply to Bob.

Bob: Thanks for bringing that to our attention. You are surely not the only ASAM member, or patient of an ASAM member, who has seen the exposition, on the web or even on their news stand in Baltimore, and wondered, ‘Huh??’

This is such a fragile topic: it occurs to me, David, that your response to Bob, or something like it, could be posted on the ASAM website, and published in ASAM News.

Sincerely
Bob Newman, MD

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RESPONSE BY DR. I plus anguish that your sentiments will give impetus to pressure to impose on buprenorphine many of the same demands and restrictions that for decades have served to exclude office-based physicians from caring for opiate-dependent patients with methadone. Individual physicans are bound by our cipher of ethics, however, to report egregious physician behavior when we are aware of it. I urge you and ASAM to do so. My hope is that the medical societies and the medical profession can work to limit these events and reply within our profession so that we do not end up with significant restrictions, from federal agencies, that limit the availability of office-based treatment of opioid dependence.

I hope you agree. Miller, MD, FASAM, FAPA
President and Board Chair, ASAM MIKE MILLER,
PRESIDENT AND BOARD CHAIR, ASAM
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David:

1. All those restricted in the 198-page publication, “Clinical guidelines for the use of buprenorphine” – to which you contributed as member of the “buprenorphine expert panel”? Fiellin’s reference to Physician Clinical Support System’s (PCSS) role in physician compliance with buprenorphine prescribing guidelines

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LETTER TO DR. 23 scoop on “strategies to control bupe abuse” are of concern. Thanks for your excellent letter to the Baltimore Sun. As they stand, however, they surely will dampen the already quite limited enthusiasm of physicians to obtain and utilize the authority to prescribe. Thanks,

David

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COMMENT BY DR.

This really is a fragile topic, and shining light on it is warranted particularly in the current environment, stirred up by the editorial board of the Baltimore Sun, in which partial truths, misquotes, and other misinformation is harming the ability to expand an incredibly successful public health intervention to more patients in need. DAVID FIELLIN:
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Bob,

Thank you for your letter.

I spoke at that press conference as Medical Director of the PCSS, not as an employee or member of ASAM.

As you have suggested, I was indeed misquoted. In any event, physicians prescribing or thinking of prescribing buprenorphine have a right to know what to

expect: the practices ASAM plans to monitor and how, and to whom non-compliance will be reported. When they are found, he said, his group will work to report them.”

Which guidelines? We have occasionally received reports about physicians who do not have a modified DEA registration who are prescribing large quantities of buprenorphine, offering no office or counseling services and the like. ASAM has no role, and CSAT’s PCSS, administered by ASAM, has no role, in monitoring physician practice, cataloging deviatiations from standards of care, or reporting physicians to regulatory or licensing agencies.

What is the plan for “finding” doctors who deviate from the guidelines?

To whom is the ASAM “group” planning to report the doctors it identifies?

It may well be that you were misquoted and/or that your remarks were distorted by being taken out of context. Notification to all waivered physicians of ASAM’s intentions should be easy to arrange. On Feb 23rd the Baltimore Sun published the following article. Or are there guidelines of specific concern based on evidence that they are causing misuse/abuse/diversion? I am additionally disappointed that the Baltimore Sun choose not to print my letter to the editor regarding their series on buprenorphine.

The guidelines that I referred to include the CSAT TIP #40 and the Guidance produced by the Federation of State Medical Boards.

Both of these documents recommend that stabilized patients be seen on a regular basis (e.g. Plants need light and mud to grow; in that case, more light and less mud would be a good thing.

Mike

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Michael M.

I wrote to seek clarification from Dr. To help them get by the reticence that you discuss.

My statement was that the PCSS mentors are encouraged to work with state medical societies whether there are concerns about inappropriate prescribing behaviors. Specifically: “’There is not an active surveillance system in place to identify physicians who are practicing outside the guidelines,’ Fiellin said. monthly) and that patients who are early on in the recovery process be seen more frequently and have access to physician and counseling services.

The PCSS has no role in active surveillance of physicians but exists primarily as an educational resource to assist clinicians in providing quality care to opioid dependent patients. I agree, it’s a shame they didn’t publish it.
3. DAVID FIELLIN
RE BALTIMORE SUN FEB 23 ARTICLE
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March 7, 2008

Dear David:

The comments attributed to you by the Baltimore Sun in its Feb. Thanks for your leadership of PCSS.
2.

Original post by RGNewman, MD