Dr. Jana Burson Blog: Who Should NOT Be in Medication-Assisted Therapy with Either Methadone or Buprenorphine?

“I spend much time and effort explaining how medication-assisted treatment for opioid addiction works for many addicts. It occurred to me that I should explain who isn’t a good candidate for such treatment.

I enthusiastically support medication-assisted treatment (MAT) of opioid addiction, but no treatment works for everyone. MAT doesn’t work for every opioid addict.” Dr. Burson offer ten reasons a patient may not be suitable for MAT including:

  • The patient isn’t addicted to opioids.
  • The patient takes opioids for pain, but has never developed the disease of addiction.
  • The opioid addict presenting for treatment has been physically dependent for less than one year.
  • The opioid addict has the ability to go to a prolonged inpatient residential treatment program for his addiction.

All this is to say that the goal of entering an opioid treatment program isn’t necessarily to
get off the treatment medication.

So if a patient seeks to enter methadone treatment but also expresses a desire to be off buprenorphine or methadone within weeks to months, I tell them their expectations aren’t realistic. These medications don’t work like that. If the patient wants to get off all medications quickly, they need referral to an inpatient program. This way, patients can’t later say they were mislead, and they feel like they have liquid handcuffs, chained forever to methadone, with its many regulations for treatment.’


Source: Jana Burson – MD  – January 5, 2014


  1. Charles L Dick Jr says

    I had read this article when it was posted to Dr Burson’s blog earlier this month, and found the information reasonable to consider and to present for and to those being considering medication assisted treatment and/or therapy for opioid addiction. Although there may be exceptions, I would feel comfortable utilizing the boundaries suggested in considering a recommendation or referral.

  2. John Mark Blowen APRN says

    Sounds like a good approach except :
    Why a year ? Not 11 months ? 10 months? 6 months ?
    Is it not true that addiction has pediatric onset and usually predates the opiate dependence ? And if addiction treatment is the goal, why not allow the person to be free of withdrawal so he or she can do the hard, painstaking and lengthy work of learning how to manage the addiction tendency that presumably exists for the entire life span ?

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