Physicians’ Clinical Support System-Buprenorphine Class in Iowa!

Iowa state flower, wild roseI’ve just discovered that one of my colleagues, Dr. Anthony Miller, MD, will be the speaker for an upcoming Physicians’ Clinical Support System-Buprenorphine (PCSS-B) Training course on May 4, 2013, Saturday, 8:00 AM to 12:45 PM at Des Moines University, Munroe Building, 3200 Grand Avenue, Des Moines, Iowa. See the announcement:

Physicians’ Clinical Support System – Buprenorphine: Office-Based Treatment for Opioid Use Disorders | Des Moines University

Opioid dependence is a jugular issue as most of my readers know, and it’s an epidemic in the U.S. In fact, a recent AMA MorningRounds item revealed that more Americans are turning to heroin because there are tighter restrictions on prescription painkillers. This is leading to a sharp uptick in heroin overdoses, crime and other public health crises.

Taken from the announcement, the reasons why this issue is critically important are:

Opioid dependence is epidemic in the United States, with increasing numbers addicted to heroin and burgeoning abuse of prescription opioid analgesics. Buprenorphine, the most recent addition to the pharmacotherapies available to treat opioid dependence, is novel among the opioid pharmacotherapies because of its partial agonist properties. It has been placed on Schedule III and is available by prescription from a physician’s office-based practice.


While we have made progress in training physicians, the gap in providing effective treatment of opioid use disorders continues to widen, moving beyond heroin addicted individuals to a much larger and diverse segment of the population. This increase is predominantly due to an alarming increase in addiction to prescription opioid analgesic medications.


In 2009, 7 million Americans age 12 and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once in the year prior to being surveyed. In 2009, 180,000 Americans age 12 and older had abused heroin at least once in the year prior to being surveyed. While not all of these individuals will go on to become addicted to opioids, a significant percentage of them will. The National Institute on Drug Abuse estimated that 23% of those who try heroin will go on to become addicted to the drug. It is also estimated that 1.9 million misusers of prescription opioid analgesic medications meet diagnostic criteria for an opioid use disorder and need treatment.


Recognizing the impact of this addiction, as well as learning how to treat opioid use disorders, is an important step in combatting this ever growing medical problem.

Dr. Miller is also the Director of our medical student clinical clerkship in psychiatry amongst many other duties. He’s a real motivator, a class act, and I don’t know where he gets his energy!


Author: Jim Amos

Dr. James J. Amos is Clinical Professor of Psychiatry in the UI Carver College of Medicine at The University of Iowa in Iowa City, Iowa. Dr. Amos received a B. S. degree in Distributed Studies (Zoology, Chemistry, and Microbiology) in 1985 from Iowa State University and an M.D. from The University of Iowa in Iowa City, Iowa in 1992. He completed his psychiatry residency, including a year as Chief Resident, in 1996 at the Department of Psychiatry at The University of Iowa. He has co-edited a practical book about consultation psychiatry with Dr. Robert G. Robinson entitled Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. As a clinician educator, among Dr. Amos’s most treasured achievements is the Leonard Tow Humanism in Medicine Award.

5 thoughts on “Physicians’ Clinical Support System-Buprenorphine Class in Iowa!”

    1. Thanks for the reminder about the abuse potential of buprenorphine. I took a quick look at your site and it contains published research papers supporting the need for everyone to be cautious about buprenorphine. I think it’s important for physicians and patients to know what you’re talking about.

      In fact, a major organization, the Federation of State Medical Boards (FSMB) publishes a book entitled “Responsible Opioid Prescribing: A Clinician’s Guide” by Scott M. Fishman, MD. Your concerns about buprenorphine and other opioid agonist replacement therapies (ORT) such as Methadone (also a potentially dangerous drug of this type) are echoed in Fishman’s book. It’s available free to Iowa physicians and they can get free CME credit by going on line to the FSMB website at

      There are so many complex medical, social, psychological, attitudinal, and cultural issues surrounding this class of drug and ORT. Just one example is the management of pregnant women addicted to opioids. The medical literature is clear: it’s potentially dangerous to both mother and baby to abruptly stop opioid or even undertake medically supervised detoxification to completely withdraw the mother from opioid. Yet, the fetus would be exposed to the risks of Neonatal Abstinence Syndrome (NAS) after delivery.

      And without ORT as an option at all, what would happen? Lately, what has been reported is that heroin abuse has escalated as access to prescription opioids has decreased. Heroin addiction is associated with death, disease, crime, and a host of other social calamities as all of us know.

      I would never attempt a superficial rationalization of ORT in light of the obvious complications attached to its use and the conflicts these issues engender in any thinking person. However, it continues to be one of the tools available to help those struggling with addictions move forward. We must do more to ensure this and other medical interventions are used as safely as possible. More research needs to be done to help us understand and treat addictions.

      Thanks again for your comments,

      Jim Amos, MD


      1. Thank you for the reply. A cursory google search of the document you refer to “Responsible Opioid Prescribing: A Clinician’s Guide” by Scott M. Fishman MD., reveals that the FSMB and the author is the subject of a Senate Investigation. Here is a quote from the website:

        “It should be noted that Fishman as well as the FSMB are currently under U.S. Senate investigation for their alleged involvement in pushing opioids for profit fueled by the pharmaceutical industry. The Senate wants answers as to whether the FSMB, Fishman and others promoted misleading information about the risks and benefits of opioids while receiving financial support from opioid manufacturers”.

        The quote and story can be found here:

        I appreciate your loyalty to your profession. But it is difficult to dismiss the influence of pharmaceutical companies on the budgets and progeny of the medical profession. The pharmaceutical industry permeates all aspects of our medical universities ( ). Medical students study textbooks written directly or indirectly by pharmaceutical companies – while they sit in classrooms in wings of buildings funded by donations from them.

        This creates a significant conflict of interest for these institutions with respect to how they teach their curriculum, which textbooks they will use, which studies they will conduct, etc. This has become even more problematic during these difficult financial times when government funding has been decreasing ( ). It is easy then, to understand how a young doctor fresh out of medical school can unwittingly be predisposed to providing treatment in a way that is in-line with the financial interests of pharmaceutical companies.

        What I can’t understand is that if uneducated people like me can see through this illusion, how come highly educated doctors can’t?



      2. Thank you for providing the links to news stories which tend to support your position. I would not call you “uneducated”. I was not aware that Fishman and the FSMB were under Senate investigation and I appreciate your bringing this to my attention.

        I wonder if you have read Fishman’s book. I have and I didn’t detect a bias in favor of pharmaceutical companies. I think the book provides information and guidance which is aligned with the best medical evidence. I still recommend it to medical students, resident physicians, and colleagues.

        I don’t think that necessarily implies I’m only being loyal to my profession. I think of myself as being loyal to patients.

        Neither does my acknowledgement of your position mean that I uncritically accept everything that is written on the web about Fishman and the FSMB. I think it’s ironic that I regularly criticize the FSMB about their role in promulgating Maintenance of Licensure (MOL, a controversial process for linking physician participation in Maintenance of Certification to medical licensure which many physicians do not support because there’s no substantial evidence that it would improve patient outcomes). Yet I’ve praised their support of responsible opioid prescribing—only to discover that many think the FSMB may not be trustworthy about this as well.

        I think what I’m trying to convey is that I have an open mind.

        I also wonder whether positional debate really moves us forward. Is it possible we could accept that both of us could be partly right and wrong about the issues under discussion? I think it would be much more constructive to focus our energies on how to best support those we both believe need our help the most.


      3. Thank you again for the reply and the tone of your response.

        It is not my first instinct to admit I’m partially wrong when that hasn’t been demonstrated. Not to say I can’t be wrong. I can be. In any event, it is difficult for someone to have an open mind when the root of the matter goes straight to the heart of their living. I do not say this as an attack, I say it because there is truth in what I am pointing to (it may not be true in your case). I believe I would be in the same situation myself if I had pursued an occupation that is responsible for the pain and suffering we see because of the prescription drug epidemic in this country. The prescription drug epidemic in this country could not be possible without the doctors who write the prescriptions for them. This is irrefutable. So it quickly becomes apparent that it is difficult to have a conversation about this subject without it “becoming” adversarial.

        In all fairness to you and the way you have responded to my comments, it does appear that you can be open to others’ views and are open to having an earnest dialogue with your readers. I hope that my blog and our dialogue has given you another point of view to consider. Thank you for allowing me to post comments on your blog…



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