Pubdate: Mon, 01 Sep 2003 Source: Boston Globe (MA) Copyright: 2003 Globe Newspaper Company Contact: http://www.boston.com/globe/ Details: http://www.mapinc.org/media/52 Author: Tobe f. Reichlin Referenced: http://www.mapinc.org/drugnews/v03.n1217.a11.html Bookmark: http://www.mapinc.org/find?131 (Heroin Maintenance) CAUTION ON HEROIN BREAKTHROUGH THE ARTICLE "New treatment offers hope for heroin addicts" (Page A1, Aug. 12) describes buprenorphine as the biggest advance in heroin treatment in decades. Believe me, I thought so, too. There is so much about it that is positive: The addict doesn't have to feel like a criminal anymore; he can simply get pills prescribed by his doctor. The pill blocks his opiate receptors so he no longer craves heroin and would actually get sick if he took it. I have a friend who struggled with heroin addiction for more than 20 years. The last five he'd been doing much better: gainfully employed, a volunteer for several community organizations, and worked out at the gym every day. In May, when we learned about buprenorphine, we thought we had found the miracle of miracles. In July he died of an overdose. On looking back, I wonder whether the pill made him feel and act so normal that it was too normal for his own good. Maybe for a person who's used to seeing the world with the rose-colored glasses of drugs like heroin and methadone, going back into the same life without the benefit of those rose-colored glasses, especially without special counseling, is just too much. Deadly overdoses are most common among recovering addicts who have been clean for some time and then relapse. Their bodies are no longer used to the heroin and are much more vulnerable to overdosing. Yes, buprenorphine is a miracle drug -- probably the most positive thing to come along in the recovery field. But expecting primary-care physicians to "both screen and treat individuals who have become addicted to opiates" after taking only eight hours of training and then expect them to dispense the drug to people who have been struggling for years with the most difficult of all addictions may be heading for disaster. A person in recovery desperately needs intensive professional counseling. Dropping a recovering addict back into life without the support systems necessary is asking for tragic, needless deaths. Tobe f. Reichlin Northampton - --- MAP posted-by: Larry Seguin