I want to congratulate Addiction Professional on publishing Steven Scanlan, MD's insightful and thought-provoking article. I'd also like to acknowledge Dr. Scanlan's incredible courage and integrity in addressing the current 800-pound gorilla in the room of the opioid addiction treatment community. It is way past time that we question the magical thinking that permeates the opioid replacement therapy (ORT) community, particularly regarding buprenorphine-based agents such as the buprenorphine-naloxone combination Suboxone. The fuzzy-headed, euphemistic language that is used by many of the ORT advocates, such as “medication-assisted recovery,” is particularly concerning when applied to long-term maintenance therapy. What needs to be clarified is that buprenorphine is an extraordinarily potent opioid, albeit a partial agonist at the opioid mu receptor. The available buprenorphine-naloxone preparations have significant abuse liability and have a long history of diversion for illicit use. What is most concerning is that much of the pharmaceutical industry-sponsored research routinely exhibits bias in favor of a positive therapeutic effect of its products. I want to be as clear as possible that I am in favor of opioid addicts receiving ORT in the privacy of their physicians' offices, provided that there has been a clear failure after detoxification and adequate abstinence-based inpatient treatment. I think we all agree on the chronic, progressive nature of chemical dependency, particularly opioid dependence. I am in favor of virtually all risk reduction strategies, including needle exchange and substitution therapies, where abstinence-based approaches have failed to effect a remission. What I believe is important is that we remember our history of pharmacologic optimism in the treatment of opioid dependence and the debris it has left behind. Again, I'd like to thank Dr. Scanlan for having the ethical fortitude to address this controversial topic honestly.