Pubdate: Fri, 22 Aug 2003
Source: LA Weekly (CA)
Contact:  2003, L.A. Weekly Media, Inc.
Website: http://www.laweekly.com/
Details: http://www.mapinc.org/media/228
Author: Steven Kotler
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

UNDER MY TONGUE

The New Face Of The Anti-Addiction Drug Buprenorphine -- Safer, Easier And
FDA-Approved 

For almost as long as people have been chasing the dragon, people have been
trying to slay it as well. The list of heroin-addiction cures comes in all
forms. Urban legend says light-bulb inventor Thomas Alva Edison came up with a
multispiced detox wonder called either "Poly-Form" or "Golden Liquid Beef
Tonic," the historical records being a little unclear. Just past the turn of
the 19th century, two New York doctors, Alexander Lambert and Charles Towns,
doled out a wondrous concoction containing the poisonous plant belladonna,
among other things. There was a pre-World War II eugenic program designed to
weed out the junkie bad seeds, which sounds mildly similar to the warehousing
of addicts via government-approved methadone clinics or the recent suggestion
that the ingestion of Tetrodotoxin, the toxin found in puffer fish, could work
as well. And last year, on October 9, the FDA approved a new potion, the drug
buprenorphine, for the treatment of heroin addiction.

Buprenorphine didn't start out as a heroin cure-all. It was discovered 30 years
ago at a time when drug companies were rushing to fill the pharmacological gap
that existed between mild analgesics like codeine and hardcore painkillers like
Percocet. Buprenorphine is a wonderful dampener with an analgesic potency 20 to
30 times stronger than morphine. For this purpose, it was first sold in the
United States as an injectable, under the brand name Buprenex.

But before Buprenex was allowed onto the market, the FDA ordered a series of
abuse liability tests, required by the DEA to ensure that any drugs capable of
becoming recreationally abused are not. The results were startling. First
published in a 1978 issue of The Archives of General Psychology, they showed
that buprenorphine -- a derivative of thebaine, a major constituent of opium --
is a narcotic agonist-antagonist, a partial agonist or an "opioid partial
agonist." Buprenorphine is more powerful than heroin -- not in terms of high,
but in terms of chemistry -- and it binds to the same receptors in an addict's
brain that opium uses. So if you're taking buprenorphine, heroin won't work.
Unlike methadone, which can be (and often is) teamed up with heroin and taken
as a speedball, buprenorphine doesn't cocktail.

Buprenorphine does produce an opiate euphoria, but the high is so mild it's
barely perceptible. "When the initial drug studies were done," says Dr. Frank
Bocci, of the National Institute on Drug Abuse (NIDA), "the first five test
subjects couldn't tell the difference between buprenorphine and a placebo." But
it is still an opiate, which means that after an addict switches from heroin to
buprenorphine, all the nasty side effects associated with dope withdrawal are
taken care of. And as far as detoxing off buprenorphine is concerned, there are
still symptoms, but according to one ex-addict I talked to, Gary, the side
effects are "about 5 percent of what heroin detox feels like."

~~~~

Gary would know. He spent eight years shooting smack and three and a half years
trying to get clean on methadone. Neither worked. In fact, methadone was worse.
"There's no way to have a life with methadone. The high is way too heavy. It's
incapacitating. And it's so much harder to kick than heroin. The withdrawal is
much more treacherous." Making matters even worse, Gary was still binging on
speedballs, the meth-smack dynamic duo that many addicts end up turning toward
to satisfy their need. Then, in the mid-'80s, he had what he refers to as "a
moment of clarity" while watching his father die of cancer, and decided to do
whatever it took to get clean.

"I heard about this guy -- Dr. Howard Mark," says Gary. "He was an L.A.-based
medical doctor who owned some kind of medical-equipment company that had gone
under and was looking for some easy cash. He stumbled across the Buprenex
research and started treating addicts. He would charge $1,000 for the first
visit, and then he would sell you Buprenex and clean needles. It didn't matter
to me. The stuff worked. I took Buprenex for about two years, I got off heroin
and got my life back."

Unfortunately, things didn't go so well for Dr. Mark. In 1989, Jason McCallum,
the adopted son of actress Jill Ireland and actor David McCallum, died while
trying to detox under Mark's care. He was cocktailing buprenorphine with other
downers and went into respiratory failure -- a danger that still exists today.
Mark lost his license to prescribe controlled substances and died a few years
ago.

One of the stumbling blocks to bringing buprenorphine to market was the lethal
reputation it earned as the cause of McCallum's well-publicized death. Still,
the fact remains that buprenorphine works, and the risks are far less than the
risks of methadone. The FDA knew all this almost 30 years ago. So what took
them so long?

"There was a lot of legislation to overcome," says Bocci. "The Harrison
Narcotic Act of 1914 says that physicians can only prescribe opiates for the
treatment of medical disorders. This was followed up by U.S. v. Webb in 1919,
which said opiate addiction wasn't a medical disorder. This is why methadone
isn't prescribed -- it's dispersed."

~~~~

In 2000, President Clinton signed the Drug Addiction Treatment Act, which
reverses earlier decisions and permits physicians (who meet certain
qualifications) to prescribe FDA-approved Schedule III, IV and V narcotic
medications for the treatment of opiate addiction. This means that specially
trained doctors (mainly psychiatrists) in the United States will now be able to
treat patients in the privacy of their offices rather than making them suffer
through the methadone circus, clearing the way for doctors to begin prescribing
buprenorphine. Currently, in California, there are 175 doctors who have taken
the required training. (To find them, go to http://buprenorphine.samhsa.gov/
and click on the "physician locator" tab.)

Also significant to the FDA approval process was the development of a
non-injectable, and therefore less risky, version of buprenorphine, the result
of a 10-year joint effort between Reckitt Benckiser, an English
household-products company with a side business in pharmaceuticals, and the
NIDA. Together they developed two different buprenorphine sublinguals (they're
dissolved under the tongue), Subutex and Suboxone.

The main difference between the two versions is that Subutex is pure
buprenorphine, while Suboxone combines the opiate with Naloxone, which is a
pure opiate antagonist (it's what smack addicts get injected with when they end
up in the emergency room). "If someone tries to crush the Suboxone and shoot it
up," says Dr. Anne Linton, who runs the Betty Ford Center and assisted with the
early buprenorphine research, "they're going to immediately find themselves
sober and going into withdrawal."

In these new formulas, buprenorphine is now much less of a liability; some
health professionals predict it will make methadone obsolete. To others,
however, there is still reason to worry. "I'm always concerned about supposed
miracle cures," says Joycelyn Woods, president of the National Alliance of
Methadone Advocates. "You want to know why it took so long to get buprenorphine
on the market here? It was introduced as a heroin cure in India, France and
Scotland. These are countries where they don't have methadone programs, but now
they have buprenorphine addicts. The DEA knew about that and was trying to find
a safer version. This is what they've come up with. We'll see if it works."
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