Pubdate: Thu, 20 Feb 2003
Source: Wall Street Journal (US)
Copyright: 2003 Dow Jones & Company, Inc.
Contact:  http://www.wsj.com/
Details: http://www.mapinc.org/media/487
Author: Peter Landers, Staff Reporter of The Wall Street Journal
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/find?136 (Methadone)

NEW DRUGS PROMISE TREATMENT FOR ADDICTS, PROFITS FOR FIRMS

Seven years ago, Steve, a chemical engineer in Texas, began craving 
painkillers. "You take three or four pills and you feel so good in just 30 
minutes. ... It's like Christmas morning," recalls Steve, who didn't want 
his last name used for fear of losing his job.

Last month he found a new drug -- one designed to cure his addiction. Known 
as buprenorphine, it eliminates cravings for painkillers but isn't 
addictive itself. Patients can get the drug privately at a doctor's office; 
around 1,000 physicians have been certified to prescribe it.

Buprenorphine is the advance guard of what could be a revolution in 
addiction treatment -- one that allows people to discreetly get help from a 
family doctor in the form of a pill. Americans have long looked askance at 
the idea of treating a drug addiction with another drug, but that is 
changing as the federal government and a handful of young drug companies 
search for treatments to help people addicted to alcohol, painkillers, 
cocaine and heroin.

The current search for an addiction treatment reminds some experts of the 
shift in attitude towards depression in the early 1980s. Many people then 
thought of depression as a character flaw, but pharmaceutical companies and 
doctors had begun to view it as a disease that could be treated with drugs. 
Today, that view is widespread, and antidepressants are a $16 billion 
world-wide market -- and growing.

"The industry has begun to wake up that this is a therapeutic area in which 
progress can be made and profits can be made," says Henry Kranzler, 
professor of psychiatry at the University of Connecticut.

Addiction is one of America's biggest public-health problems, with an 
estimated 14 million adults suffering from alcoholism or alcohol abuse, and 
millions more abusing hard drugs such as heroin. Still, treatment remains 
confined mostly to counseling or psychotherapy.

Buprenorphine is the furthest along in a series of promising new drugs that 
may have the potential to change that. Made by Reckitt Benckiser PLC of 
Britain, it is one of several treatments that have been known for years to 
help with addiction and were welcomed in Europe, but not in the U.S.

Doctors also are studying a couple of drugs geared toward helping 
alcoholics kick the habit. One, called naltrexone, has already been 
approved for use in the U.S., though there is disagreement over how, and 
how often, to administer it.

Far from a simple medical issue, many Americans see addiction as a legal, 
even moral problem, and for most of the 20th century, doctors shied away 
from treating addicts. Groups such as Alcoholics Anonymous, blending 
self-improvement with a quasi-religious fervor for abstinence, filled the 
vacuum. The view of addiction as a crisis of willpower was crystallized in 
Nancy Reagan's "Just Say No" campaign in the 1980s.

But in the 1990s, scientists began to discover how addiction rewires the 
brain so thoroughly that addicts scarcely have a choice in taking another 
drink or pill.

Safer Than Methadone

Buprenorphine turns on the same receptors in the brain's neurons as opiate 
drugs, which include prescription painkillers. Unlike other opiates, 
however, buprenorphine isn't highly addictive and doesn't produce a 
powerful high.

Some specialists object to replacing one drug with another, but that view 
is changing. Currently more than 170,000 Americans who are addicted to 
opiates are treated with methadone, which also is a primary treatment for 
the growing problem of painkiller addiction.

Buprenorphine, sold in pill form, is less addictive than methadone and also 
less dangerous if users overdose. Unlike methadone, which is distributed 
mostly at special clinics, buprenorphine is administered in doctor's 
offices. It also is much harder to sell on the black market because it 
causes withdrawal symptoms if users inject it seeking a high.

Peter, a 22-year-old New Yorker who works in the computer industry, became 
addicted to painkillers as a teenager, then graduated to heroin. For two 
years, he flew to France to get buprenorphine, but recently got a 
prescription from a doctor at home for the first time. The drug stops 
cravings so well, he says, "you tend to forget that you have a problem."

Buprenorphine, which like all addiction drugs, works best in combination 
with behavioral therapy, isn't right for everyone. Patients on 
buprenorphine can use it safely for as many years as the addiction exists, 
doctors say; those who want to stop can gradually reduce the dose. Doctors 
need eight hours of training and a special certification to prescribe 
buprenorphine.

Progress in treating addictions to other substances has been slower, but is 
building. Naltrexone, the main approved medication for alcoholism, has been 
on the market since 1995, but the pill has to be taken daily, a discipline 
recovering alcoholics find hard to achieve.

DrugAbuse Sciences Inc., a privately held Hayward, Calif., company, now is 
testing a naltrexone dose that would be injected once a month in the 
patient's buttocks at a doctor's office. After more tests, the company 
expects next year to seek government approval to sell the drug.

Alexander DeLuca, a New York doctor who has treated alcoholics -- and has 
clashed with proponents of abstinence -- recommends an alternative use of 
naltrexone. The drug should be taken before craving strikes, he says, such 
as before a party. Studies suggest the drug retards the mild euphoria of a 
drink, helping alcoholics imbibe moderately.

Many had expected another medication for alcohol abusers, called 
acamprosate, to be available by this year. Widely used in Europe, where 
studies have shown it works better than a placebo in cutting drinking, the 
drug has failed to gain approval from the Food and Drug Administration 
because of inadequate data. The drug's maker, Merck KGaA of Germany, no 
relation to U.S.-based Merck & Co., says it plans to resubmit its 
application to the FDA in May.

Cocaine Vaccine?

The FDA has yet to approve any medication for cocaine addiction, but 
several major studies are under way. The National Institute on Drug Abuses 
is now studying whether selegeline, a drug approved for Parkinson's 
disease, can help cocaine addicts. Results are set to be revealed in a few 
months. In addition, Britain's Xenova Group PLC is working on a vaccine 
designed to create antibodies that would attack and destroy cocaine 
molecules before they could get to the brain. Research is still at an early 
stage, and even if successful, the drug wouldn't hit the market for many years.

Frank Vocci, the head of medication development at NIDA, puts all the drugs 
now available for addiction in the "first-generation" category. Medications 
that can actually reverse the effects of powerful drugs of abuse are at 
least "eight years-plus away," he says. "I don't see something happening 
much faster than that."
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