Dr. David Fiellin, a Yale University professor who directs the Physician Clinical Support System, said that "there are physicians who are practicing outside" the standards of care.
Fiellin said the support system, funded by the government, will work with private medical societies to teach doctors how to properly store the medication and to identify patients who might be misusing or selling the drug.
"There is not an active surveillance system in place to identify physicians who are practicing outside the guidelines," Fiellin said. When they are found, he said, his group will work to report them.
Dr. Charles R. Schuster, a former director of the National Institute on Drug Abuse who tracks abuse of the drug for the manufacturer, agreed.
"We have reports from physicians that they know of other physicians not practicing within the standards of care," Schuster said.
The biggest problem, according to Schuster, is that some doctors are prescribing 30-day supplies of the pills to addicts after only a single visit. While that's legal, Schuster said, doctors should become comfortable that a patient is not abusing the drug before prescribing large amounts.
"A small minority of doctors are not practicing good medicine," he said. "That's a problem we need to be concerned with."
Experts and officials identified other problems, including doctors who provide little counseling. An official with the NIDA said studies are showing that buprenorphine works better with pain-pill addicts, not heroin abusers.
Schuster also said he learned at the two-day conference that federal government drug-abuse warning systems were considering ways to add new medications to their watch lists.
"Currently they are designed for detecting the use and abuse of drugs that have been around for quite a while," he said.
Dr. Celia Winchell, a medical officer for the U.S. Food and Drug Administration, which approved Suboxone in late 2002, acknowledged that some abusers are able to crush the pills and inject the drug despite the presence of a chemical intended to deter that.
"Certainly, we're concerned about diversion and abuse," she said.
Winchell said the FDA is evaluating whether to strengthen warnings on the drug labels to "prevent diversion" and alert doctors and patients to adverse effects that accompany misusing it.
"We're exploring if there's anything left unsaid in packaging," Winchell said.
But the government can do little to alter doctors' practices. The Drug Addiction Treatment Act of 2000, which authorized buprenorphine treatment, forbids the government from interfering in private medicine.
Federal regulations allow doctors to prescribe a 30-day supply of buprenorphine and up to five refills, a practice that is far more lenient than in most countries.
Canada, for instance, requires that a patient be in treatment for two months before receiving Suboxone to take unsupervised.
doug.donovan@baltsun.com fred.schulte@baltsun.com
