Pubdate: Thu, 19 Oct 2000
Source: Washington Post (DC)
Copyright: 2000 The Washington Post Company
Contact:  1150 15th Street Northwest, Washington, DC 20071
Author: Fredrick Kunkle, Washington Post Staff Writer


Heroin addicts would be able to obtain prescriptions for treatment with 
promising new drugs in the privacy of a doctor's office under a bill signed 
into law by President Clinton late Tuesday.

Marking a significant departure from attitudes that have governed the 
treatment of opiate addicts for 86 years, the Drug Addiction Treatment Act 
of 2000 permits qualified physicians to prescribe take-home doses of a mild 
narcotic, buprenorphine, to people addicted to heroin or prescription 

"It's revolutionary, I think, making it much more broadly available," said 
Thomas Kosten, professor of psychiatry at Yale University's School of 
Medicine. "It will help remove some of the stigma associated with opiate 

The Food and Drug Administration still must give the go-ahead on the use of 
buprenorphine for treating narcotics addiction, but federal health 
officials say this is expected any day.

"I've heard nothing from the FDA that would suggest this is not going to 
happen," said H. Westley Clark, director of the U.S. Health and Human 
Services Center for Substance Abuse Treatment. Clark said buprenorphine 
could be on the market for use in opiate detoxification and maintenance as 
soon as January.

Developed by the National Institute on Drug Abuse and Richmond-based 
Reckitt Benckiser Pharmaceuticals Inc., buprenorphine is an alternative to 
methadone, a proven treatment hindered by the fact that it is dispensed at 
highly regulated clinics in daily doses.

Buprenorphine, a narcotic already used as an injectable painkiller, is 
powerful enough to block the craving for heroin. But its unusual chemical 
properties make it longer-lasting, less addictive and--because it does not 
suppress breathing--less likely to trigger a fatal overdose than methadone 
or other opiates.

"It's the kind of drug that, like methadone, prevents you from withdrawing, 
but also prevents you from experiencing the euphoria you experience with 
heroin," said Michael L. Fox, medical director of the chemical dependency 
unit at St. Mary Mercy Hospital in Livonia, Mich.

Federal officials estimate that there are from 500,000 to 1 million heroin 
addicts in the United States, but only about 200,000 in treatment. By 
moving narcotics treatment away from government-sanctioned clinics, federal 
health officials hope to reach heroin addicts in rural areas and 
middle-class drug users who shy away from methadone clinics for fear of 
being seen. The widespread use of buprenorphine could limit the spread of 
methadone clinics and the battles that often flare in neighborhoods 
whenever a new clinic is proposed.

Marketed under the brand names Subutex and Suboxone, the drug would be 
available in tablets that addicts would place under their tongues. "My 
biggest fear is there won't be sufficient funds for the people who are 
addicted to be able to get this . . . anti-addictive medication," said Sen. 
Carl M. Levin (D-Mich.), a sponsor of the bill. Though the cost of 
buprenorphine isn't yet known, federal health officials already are 
exploring ways to make it affordable, Clark said.

Charles P. O'Brien, chief of psychiatry at the Veterans Administration 
Medical Center in Philadelphia, said the new law represents a major shift 
in attitudes away from viewing addiction as a moral vice toward seeing it 
as a chronic disease like diabetes.
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