GIVE THEM CHOICES

I read the article on the politics of addiction ["Cover Story," Jan.
30] that was devoted primarily to the controversy surrounding the use
or lack of use of methadone in San Diego.

Heroin and similar drugs, collectively called "opioids," are the
second most extensively studied drugs after alcohol. Unlike alcohol or
drugs like cocaine and methamphetamines, opioids selectively bind with
specific neurons in the brain called the "opiate receptors" and cause
both beneficial effects like pain relief and also addiction.

Thanks to this knowledge, we have three distinct medications to treat
opioid addictions--more than any other addictive drug except alcohol.
The first and the most extensively used medication, and also the most
controversial, is methadone, which binds with the opiate receptors,
causing complete activation, but not to the same extent as heroin,
thus breaking the cycle of withdrawal and cravings. The second
medication is buprenorphine, better known by the trade name Suboxone.
Buprenorphine binds with the opiate receptors, causing only partial
activation. The third is naltrexone, which binds with the opiate
receptor and prevents any activation.

Buprenorphine can be prescribed by physicians who have received the
required training. Naltrexone, being a non-narcotic, can be prescribed
by any licensed physician.

Successful treatment demands giving patients' choices. Not all
patients are going to benefit from just one drug, be it methadone,
buprenorphine or naltrexone. Most opioid patients are not aware that
they have treatment choices, and the methadone clinics don't offer
patients any choices. They offer just one drug--methadone. It's like a
diabetes clinic offering patients insulin as the only treatment.

Advancement in the understanding of addictions has led to a quiet
revolution. Addicting and potentially harmful drugs are being replaced
by non-addicting and safer medication. Not too long ago,
benzodiazepines like Librium and Valium were considered the "gold
standard" for the treatment of alcoholism. We now have medications
like acamprosate and naltrexone.

The "gold standard" is offering patients treatment
choices.

Percy Menzies, Assisted Recovery Centers of America

St. Louis, Mo.