TREATMENT FOR OPIATE ABUSE CAN HELP PEOPLE OVERCOME ADDICTION

As a highly trained physician, with 20 years of emergency room
experience and American Board of Emergency Medicine certification in
emergency medicine, and newly completed residency training and just
completed testing for board certification by the American Board of
Psychiatry and Neurology, I need to both complement Laura Duncan for
her excellent article on drug and heroin abuse and addiction in our
community, but also point out a glaring and inexcusable gap in her coverage.

That gap is the failure to mention a treatment for opiate
abuse/dependence that is and has been available here for two years in
the form of a tightly controlled drug called buprenorphine, trade
name Suboxone. Both I, as the leading prescriber of this drug locally
and a very few other physicians, have been trying to attack the
epidemic of drug abuse among the teenagers, housewives, construction
workers, businessmen and people from every corner of our society for
some time, with very little help, as it turns out. And then comes a
front page article that doesn't seem to know that this treatment even exists.

After all the challenges I have had to face in trying to establish a
practice here, I find this one to be the most horrifying. I am
especially surprised because both of the people mentioned in the
article are well aware of our existence and the methadone clinic that
was mentioned, where Dr. Symond worked. This clinic had initially
contracted me to be its medical director before turning to Dr. Symond
and then simply walked away from it when they decided that my
prescribing Suboxone would be a conflict of interest or some such
thing. With that said, let me tell you about the benefits of Suboxone
over the use of Methadone as a treatment for heroin or opiate (pain
killer) dependence. First, Suboxone has been available on a limited
basis for at least four years. It is available, by prescription, from
doctors who have completed a short training course and received a
special DEA license certification number. Any licensed physician can
obtain one, including general and family practice physicians, for
whom this drug was especially developed. However, the license limits
each physician and each clinic, no matter how many physicians in the
clinic, to a maximum of 30 active Suboxone patients at a time. That's
the big catch, at least for the time being. Suboxone acts differently
than methadone in that it does not prolong or, as methadone often
does, increase the persons dependence on opiates, because it has a
very low tendency to stimulate the brains opiate centers. However,
when dosed correctly, it removes all of the physical manifestations
of opiate withdrawal as well as the cravings, and blocks the effects
of other opiates if the patient attempts to "get high."

In short, it is a far better treatment for opiate dependence or
abuse, than methadone and can be made available without having to go
to a specially designated methadone clinic. Patients are also allowed
to take their prescriptions with them, rather than having to show up
to the methadone clinic every day to get their medication.

The major challenge of prescribing Suboxone is the treatment of the
addicted patient and the disease and nature of addiction itself,
which is just in recent decades starting to be understood. These
patients take a lot of time, which is why family practitioners shy
away from prescribing it, and can be very demanding and disruptive to
a clinic or doctor's office.

As a specialist in psychiatry and emergency medicine, I am
well-equipped to handle these patients. However, like other
physicians, I am limited to only 30 active patients at a time and,
were I to advertise, I would expect my clinic to be overrun with the
already long, and increasing, waiting lists of people trying to get
off of the diabolical merry-go-round of addiction.

I also spend a great deal, and probably excessive amounts, of time
with all my patients, whether they come to me for addiction or
whatever problem they might have and I treat all forms of psychiatric
illness, not just addiction. Nevertheless, to leave it out of an
article of this kind is a huge oversight that I felt I needed to correct.

David R. Kramer, M.D.