Pubdate: Tue, 18 Dec 2007
Source: Baltimore Sun (MD)
Copyright: 2007 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Bookmark: http://drugnews.org/topics/Buprenorphine  (Buprenorphine)
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)

OVERCOMING ADDICTIONS

It's disappointing - although not surprising - that a  promising drug 
in the fight against addiction has  become a sought-after narcotic in 
the illegal drug  market in some areas of the U.S. and in other 
countries. As detailed in a series in The Sun that  concludes today, 
buprenorphine is being abused by some  patients and black marketeers, 
who sell it for profit  or combine it with other drugs for a 
different kind of  high.

This drug "diversion" is not unusual and is no reason  to give up on 
"bupe," which has helped relieve  addiction to heroin and 
prescription painkillers, such  as OxyContin. A key solution is to 
put more safeguards  in place, including more training for doctors 
and counseling for patients.

Buprenorphine helps take away the craving for heroin  but doesn't 
require addicts to show up at a clinic each  day, as they do with 
methadone. It can allow addicts to  work productively and to reclaim 
their lives.

But in parts of New England and in France, as the Sun  series shows, 
bupe has become its own drug of choice, a  substitute of one opiate 
for another. Some doctors are  prescribing it for short-term relief 
from early heroin  withdrawal, when it is more appropriate as a 
long-term  antidote to addiction.

Despite such misuses, bupe is still better than heroin  and retains 
enormous potential to save lives.  Baltimore's health commissioner, 
Dr. Joshua M.  Sharfstein, insists that the version of the drug being 
used in approved treatment centers here is more  difficult to subvert 
into other forms that can be  injected, either by itself or in 
combination with other  drugs. Even though addicts are introduced to 
bupe while  in treatment so that they can be stabilized and 
monitored, many addicts continue to use heroin and  other drugs, and 
others fear substituting one addictive  substance for another.

Overcoming addiction can be a lengthy, complicated  process, and 
doctors and patients could use more  navigational help. Federal law 
requires doctors who  prescribe bupe to take eight hours of training, 
but  that may not be enough. The training requirements could  be 
expanded, including more peer mentoring as the pool  of doctors 
allowed to prescribe the drug increases.  Similarly, more patient 
counseling should be provided,  along with expanded support services.

Such improvements could go a long way toward enhancing  bupe's 
effectiveness and realizing its promising  potential to help 
thousands more addicts.
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MAP posted-by: Jay Bergstrom