Pubdate: Mon, 23 Oct 2000 Source: Bangor Daily News (ME) Copyright: 2000, Bangor Daily News Inc. Contact: http://www.bangornews.com/ Author: Jeff Tuttle METHADONE ALTERNATIVE COMPLICATES BANGOR - Opponents of a proposed methadone clinic here applauded President Clinton's recent approval of an alternative drug, putting yet another wrinkle in debate about the controversial clinic planned for the city. "This should change everything," said Robert Q. Dana, a drug addiction specialist at the University of Maine, an opponent of the clinic. "I think this suggests that we should clearly step back and get our focus on what's happening at the national level." Under the Drug Addiction Treatment Act of 2000 signed by the president, the drug buprenorphine still needs approval from the federal Food and Drug Administration before it can be used to treat opiate addiction. The narcotic is currently approved for use as an injectable painkiller. FDA approval is expected any day, federal health officials say. The new development attracted the attention of officials at Acadia Hospital, who likewise welcomed the alternative while noting the methadone option still is needed to treat opiate addiction. "It doesn't change anything at all," Lynn Madden, vice president of administrative services at the Bangor-based hospital, said of the new drug's effect on plans for a methadone clinic. "We'll continue to use whatever drugs are most appropriate for our patients, and for some folks, there's still a place for methadone." Acadia, at the request of the state Office of Substance Abuse, applied in February to open a methadone clinic at its Indiana Avenue facility. The prospect of the clinic has since divided the community, prompting the City Council to form a special committee on opiate addiction to study the regional problem and the need for a methadone clinic in the city. The committee will next meet at 6 p.m. Tuesday in the City Council chambers at City Hall. Among the items to be discussed at the meeting are alternatives to methadone, including buprenorphine. Buprenorphine, like methadone, blocks an addict's craving for heroin or prescription painkillers. Unlike methadone, however, buprenorphine is longer lasting, less addictive and less likely to result in a fatal overdose because it does not suppress breathing. But while the drug may be all those things, it is also less potent, said Dr. Paul Tisher, the hospital's vice president of medical services, and therefore not a substitute for methadone in cases of severe and entrenched addiction. "What we know about buprenorphine is what we've read, and right now it's not clear that buprenorphine is going to be up to the task of stabilizing those with severe addiction problems," Tisher said. Should FDA approval come as quickly as expected, the drug could be prescribed for heroin and opiate addicts in the privacy of a doctor's office as soon as January. The new practice would mark a significant departure from the present routine of dispensing methadone in daily doses at a central, government-sanctioned clinic, Dana said. "Making this kind of treatment less invasive will only be beneficial because the research is very clear that less invasive treatments produce better outcomes," Dana said. "It's about respect and dignity for these patients." Dana predicted the new drug would bring into treatment those addicts who previously shied away from methadone clinics for fear of being seen. The Maine Department of Mental Health, Mental Retardation and Substance Abuse Services agreed to postpone the licensing of the Bangor methadone clinic until January 2001, at which time the council's special committee is expected to issue its final report. Kimberly Johnson, director of the state Office of Substance Abuse, also said there were no plans to scrap the methadone clinic in favor of the relatively new treatment option. "If it turns out to be way more effective than methadone, that could be one thing," Johnson said. "But it's just too soon to say." - --- MAP posted-by: Terry F