Pubdate: Mon, 3 Feb 2003 Source: Detroit Free Press (MI) Contact: 2003 Detroit Free Press Website: http://www.freep.com/ Details: http://www.mapinc.org/media/125 Author: Emilia Askari, Free Press Staff Writer Bookmark: http://www.mapinc.org/rehab.htm (Treatment) Bookmark: http://www.mapinc.org/find?136 (Methadone) NEW DRUG GIVES ADDICTS A WAY OUT Buprenorphine May Be A Key For Abusers Of Heroin, Painkillers Odis Rivers was hooked on heroin for 20 years. He says he tried to stop a thousand times without success. Then he heard about a professor at Wayne State University who was offering addicts a new way to quit: taking a new medication called buprenorphine. Rivers signed up for the clinical trial in 1997. He hasn't used heroin since. In 1999, he tapered off of buprenorphine and says he has been drug-free for more than two years now. Rivers has told his story to doctors, senators and countless family members and friends. Today, he will tell it again at a public seminar in Detroit organized by the federal Substance Abuse and Mental Health Services Administration. Rivers and federal experts say buprenorphine can be life-changing not only for heroin addicts but also for the rapidly increasing numbers of people abusing pain-killers, which can mimic heroin's effects on the brain. "I was having big withdrawal symptoms. It eased all of those symptoms down," Rivers said last week. "That way, I was able to think clearly and make good decisions. It turned my life around." Rivers of Baltimore lived in Detroit until he finished the Wayne State study two years ago. The seminar, which begins at 9:30 a.m. at Coleman A. Young Municipal Center, is the first in a series of similar events scheduled for 14 cities nationwide. Their purpose is to educate patients, doctors and other drug-treatment professionals about buprenorphine, which just reached pharmacies in January. Alternative to Methadone The medication offers tens of thousands of addicts in Michigan -- and millions across the country -- an alternative to methadone, which for three decades has been the predominant choice, besides quitting cold turkey. Dr. Vipul Patel, who works in a Henry Ford System substance-abuse clinic on Maple Road in West Bloomfield, is one of 19 Michigan doctors who have received government clearance to prescribe buprenorphine. "I haven't had any chance to use it yet," he said last week. "But I want to help my patients. I want to see if it's a better alternative." U.S. Sen. Carl Levin, D-Mich., also will speak at the seminar, along with federal officials and several local doctors and drug-treatment experts. Levin sponsored a 2000 law that established the conditions under which doctors can prescribe buprenorphine. "Narcotics are such a huge drain on our community as well as our families," he said last week. "This opens up such great potential. It's an important new weapon in the war on drugs." Buprenorphine holds promise for addicts of opiate drugs, which include heroin and many pain killers, such as darvon and codeine. For years, heroin was the most-abused drug in the family. Recently, however, abuse of pain-killers has soared as doctors focused more on pain control and prescribed more painkilling drugs. Now, the number of people abusing painkillers nationwide exceeds the number who use heroin, according to the Substance Abuse and Mental Health Services Administration. While heroin has the image of a "street" drug linked to poverty and crime, painkilling drugs often are abused by middle-class people with jobs and families. Detroit ranks sixth among major U.S. cities tracked by the federal government for abuse of painkillers, according to the substance abuse administration. It ranks eight in heroin use. Buprenorphine, sometimes called "bupe," has several advantages over methadone for treating addiction to heroin or painkillers. The primary advantage is that any doctor who goes through a day of special training and registers with the government can write a prescription for buprenorphine. Methadone is heavily regulated and dispensed only from drug-abuse clinics that require patients to stand in line daily and drink their dose in front of a nurse. Buprenorphine is a pill that can be taken as infrequently as once every three days -- in the privacy of the addict's home. Currently, health officials estimate that only 20 percent of heroin addicts are trying to quit with methadone. The percentage of painkiller addicts using methadone to try and kick their habit is thought to be much smaller. "It is so insensitive and stigmatizing that people have to go to a methadone clinic," said Dr. Calvin Trent, director of the Detroit health department's bureau of substance abuse. "It's really good that people will be able to get this new medication from their family doctors." Opiate Withdrawal Both methadone and buprenorphine reduce or eliminate withdrawal symptoms and craving for heroin or other opiates, such as painkillers. But users can easily become hooked on methadone, taking the medication for many years. Buprenorphine is easier to quit, according to doctors who have studied it. Also, it's much harder to overdose on buprenorphine. In fact, if you try to take a lot of it you won't get high because the medication has a "ceiling" effect, said Robert Lubran, director, division of pharmacologic therapies of the government's Substance Abuse and Mental Health Services Administration. In fact, buprenorphine is commonly mixed with another medication that actually will induce withdrawal symptoms if it is taken in larger-than-prescribed doses. Some drawbacks of buprenorphine, which is produced in the United Kingdom by a conglomerate called Reckitt Benckiser, better known as the maker of French's mustard and cleansers such as Lysol and Woolite: * Buprenorphine costs about $10 a dose, compared to $3 a dose for methadone. * It's still not known the cost of the new medication will be covered by Medicaid and various HMOs and insurance companies. * Buprenorphine cannot help some people who now need very high doses of methadone to reduce their drug cravings. * It doesn't necessarily come with the psychological support and counseling that is required at methadone clinics. * It can kill patients who try to overdose on buprenorphine in combination with other drugs such as alcohol. "It's not a totally safe drug. I don't think any drug is totally safe," Lubran said. "It's another treatment option. We hope this is going to be the new path to recovery." Painkilling Treatment Buprenorphine is itself a painkiller. It has been used to treat opiate addiction for more than six years in France, during which time the number of opiate-abusers there has fallen dramatically. Buprenorphine now is sold throughout Europe for opiate treatment. The Federal Drug Administration approved it for that use in the United States last October. The government plans to allow 6,000 doctors nationwide to prescribe buprenorphine. Each will be permitted to prescribe the drug to no more than 30 patients at a time. "We have many antibiotics," said Dr. Charles Schuster, director of Wayne State's addiction research institute and the professor who helped Rivers and about five dozen other heroin addicts quit using buprenorphine. "We need to have more than one way to treat opiate addiction." For more information about buprenorphine, go to www.buprenorphine.samhsa.gov. For a list of other doctors who can prescribe the medication, go to the www.samhsa.gov, click on Addiction Treatment, then Office-based Treatment, then Physician Locator, then Michigan. - --- MAP posted-by: Doc-Hawk