HTTP/1.0 200 OK Content-Type: text/html Greater Access To Treatment Hailed
Pubdate: Sun, 07 Aug 2005
Source: Boston Globe (MA)
Copyright: 2005 Globe Newspaper Company
Author: Peter  DeMarco
Bookmark: (Heroin)
Bookmark: (Methadone)
Bookmark: (Oxycontin/Oxycodone)
Bookmark: (Treatment)


For addicts such as Elizabeth Fabiano, the news from Washington is cause 
for uncustomary hope. A federal limit on a medication that has been used to 
treat thousands of OxyContin and heroin addicts was lifted last Tuesday, 
opening the  door for hundreds of addicts across Boston to immediately 
begin treatment after  months or even years on waiting lists.

"I've been a user for 20 years, and it's the only thing that's helped," 
said Fabiano, 38, speaking from a pay phone at the Pine Street Inn. "I 
don't know  what it does to you, but you don't even think of [heroin] when 
you're on it.  I've been on a waiting list since May. I can't wait to take 
it." But greater legal access to buprenorphine, an opiate taken in pill 
form, still does not mean it will be available to everyone who seeks it, 
health officials said.

Waiting lists at some of the city's largest hospitals are hundreds of names 
long. Even the best-equipped treatment programs will need time to enroll 
patients, officials said.

Most doctors' offices, health care clinics, and smaller hospitals do not 
have staff certified to administer the drug, or lack the resources to 
properly manage  an outpatient program. Dorchester House Multi-Service 
Center, for example, does  not have anyone on staff who has taken the 
federally required eight hours of  training to prescribe buprenorphine. At 
Codman Square Health Center, just one  physician, Dr. Jonathan Pincus, is 
certified to administer it. "Until someone goes and gets trained, we'll 
have a 30-patient limit," he said. Licensing is required because the drug 
is the first opiate treatment that can be prescribed by a primary care 
physician. Statewide, a substantial number  of doctors who have been 
certified do not prescribe buprenorphine because of the  stigma of inviting 
addicts into their waiting rooms. "We sent out letters to all physicians to 
say if you're not prescribing, tell us why," said Michael Botticelli, 
assistant commissioner for substance abuse service at the state Department 
of Public Health. "I think there's a feeling among physicians that this 
population is not their current population.  In some case, there's denial 
that there might be opiod-based addicts in their practice. Also, they're 
not sure how to handle this from a counseling perspective."

Despite such issues, Colleen Labelle, nurse-manager of Boston Medical 
Center's Office-Based Opioid Treatment Program, said the lifting of federal 
limitations is a watershed. Methadone remains the only treatment option for 
some addicts, experts say. But for others, buprenorphine can end cravings 
for street drugs without producing a high, allowing addicts to hold jobs or 
simply save their lives.

"Six kids have died in Brockton under the age of 23 since Jan. 1 from 
OxyContin," Labelle said. "One was 19 and five months pregnant, found in 
her  bed by her mom. She was on my waiting list."

Other health care officials are optimistic of quick change now that the 
limit has changed.

The previous law, passed in 2000, limited individual clinical practices 
from treating more than 30 patients with buprenorphine at a time, but did 
not distinguish among single-physician practices, hospitals, and health 
care organizations. As a result, the 200 doctors belonging to Boston 
Medical Center's internal medicine practice could treat a combined 30 
patients. Harvard Vanguard, which has 14 clinics throughout Greater Boston, 
was likewise limited to treating  just 30 patients.

The new law allows a single doctor to treat 30 patients after passing a 
certification course.

"We actually have four certified physicians, so the practical effect of 
this is we immediately go from a capacity of 30 patients to a capacity of 
120 patients," said Dr. Steve Adelman, a psychiatrist with Harvard 
Vanguard. John Auerbach, executive director of the Boston Public Health 
Commission, said his agency already offers free training programs for 
doctors and a free hot line with on-call physicians who can field treatment 
questions. He said he expects the number of city residents receiving 
buprenorphine -- sold under the brand name Suboxone -- to double within a year.

Fabiano, once a State Street Bank employee who has battled addiction since 
she was in her 20s, said she stayed clean on buprenorphine for eight months 
before missing an appointment with Labelle in March and dropping out of 
treatment. Two days later, she started using heroin again. "I see her every 
week now. 'When can I get on the list?' " Fabiano said. "This time, I will 
never miss an appointment. If she tells me to come every day, I will."
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