Pubdate: Sat, 16 Aug 2003
Source: Kentucky Post (KY)
Copyright: 2003 Kentucky Post
Author: Shelly Whitehead
Bookmark: (Treatment)


There's this Northern Kentucky guy, works at a big Cincinnati company, but he
was hooked on heroin.

He was finally getting clean though, on methadone at the East Indiana Treatment
Center in Lawrenceburg.

Except one day he's standing in line for his methadone dose when he spots his
boss up ahead of him. When his boss sees him, he tells him, "You say anything
to anybody and your job is gone."

Taylor Mill family practitioner Dr. David Suetholz tells that story to explain
one big reason why he thinks buprenorphine -- a drug recently approved by the
FDA to treat opiate addicts at their doctor's offices -- is a revolutionary
addiction-fighting tool.

Unlike the two other opiate addiction treatment drugs, methadone and the
lesser-known ORLAAM, buprenorphine treatment offers privacy and accessibility
benefits because it can be administered at a certified physician's office.

Suetholz says he not only likes the way the drug itself works to block an
addict's abuse of drugs like heroin, methadone and OxyContin, he also likes its
potential to expand treatment options available for what he and others deem to
be a rapidly expanding population of local opiate addicts.

In his dual roles as Kenton County coroner and Taylor Mill family practitioner,
Suetholz sees opiate abusers at every stage of addiction.

From the addicted patients he cannot legally prescribe methadone maintenance
therapy for, to the 14 people who have died this year in Kenton County of
overdoses of the drugs. Sadly, he says, the addicts keep on coming.

"People call my -- . office every single day," he says unequivocally.

It is largely for that reason that Suetholz was among this area's first
physicians to attend training last April to treat addicted patients with

The relatively old pain drug, actually an opiate itself, received FDA approval
last October for its new use as a treatment for opiate addiction.

"It's a sublingual dissolvable wafer that links on to the same receptor sites
other opioids do," said Suetholz, explaining how a buprenorphine dose, placed
under the tongue, acts like a chemical firewall, preventing other abused
opiates like heroin from creating the euphoric high addicts seek.

"So they don't get high like they normally would on their other meds. And if
they take too much (buprenorphine) they actually end up developing withdrawal

Excitement about the drug's potential has as much to do with the way it's
administered as the way it works to wean addicts away from powerful opiates
like Oxy-Contin, morphine, heroin and even methadone.

Many addicts locally, for instance, cannot or will not make the daily trips to
the nearest available methadone clinic in Lawrenceburg.

In fact, Suetholz just had his prescription-writing privileges reinstated after
the state suspended them for 11 months claiming the doctor violated federal
drug laws by prescribing methadone for a handful of his addicted patients who
refused to go elsewhere for treatment.

Buprenorphine not only offers a treatment alternative to the patient but to
communities as well. Northern Kentucky, like many communities nationally, is
brimming with opiate addicts aching for methadone maintenance programs closer
to home. Buprenorphine treatment may address the stigma and accessibility
problems of methadone maintenance programs locally.

And physicians say buprenorphine not only blocks the high of other opiates, the
drug itself cannot be abused to achieve the addict's much sought-after high. In
a year marked by a steep increase in methadone overdose deaths locally, that
quality could be a benefit over the oft-abused and trafficked methadone.

Still buprenorphine is not a problem-free treatment. Some, like Kentucky
methadone programs administrator Mac Bell, say the drug has numerous

"It's not just for every opiate addict," said Bell. "For instance, long-term
opiate addicts who are shooting a lot of drugs every day, it's not appropriate
for (them) and it won't be effective. But for those on low-dose narcotics -- 60
mg or lower of methadone -- it might be appropriate for. So I think it will
serve some purpose, especially (offering) treatment from physician's offices.
That takes some of the stigma away."

Ironically, buprenorphine treatment presents an all-new kind of stigma problem,
this time for physicians who must consider how operating in-office drug
addiction treatment might affect their other patients.

"A lot of community doctors don't want to get involved in treating addictions
because there's a lot of potential risks," said Cincinnati Drug and Poison
Information Center Director Dr. Earl Siegel.

"Addicts are not the easiest patients. Plus there's a legal risk to (the
doctor) and a safety factor for themselves and their other patients."

These are all factors Suetholz is mulling over now that he has received the
training which would permit him to treat addicts with buprenorphine if he
simply completes the process to amend his federal narcotics license.

He went to the training, sponsored by the American Society of Addiction
Medicine, in Washington, D.C. in April.

Suetholz says the sting of the state licensure board's recent sanction still
lingers. And, as a small business operator, he says, the new treatment addition
poses the specter of additional manpower, office space and business expense

But then as a medical doctor and coroner, he considers the desperation of his
addicted patients and the devastated families of the 14 people who have died of
opiate overdoses this year. Buprenorphine might offer hope, but his mind is not
made up.

"You can't just give it to them the first time, then adios them," Suetholz
said, explaining that patients must be closely monitored with intensive
follow-up and health monitoring, ongoing drug screening, all accompanied by
detailed, federally required documentation.

All that must then somehow be fitted manageably inside, what for Suetholz is,
an already bustling medical practice. Like many of the physicians attending
buprenorphine treatment training last spring, Suetholz also left with second
thoughts about adding drug addiction treatment to their practices.

"A lot of people just say they'd like to do it, but they don't want to get into
all the hassles," Suetholz said.
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