NEW LAW ALLOWS SHIFT IN HEROIN TREATMENT

Heroin addicts would be able to obtain prescriptions for treatment with
promising new drugs in the privacy of a doctor's office under a bill signed
into law by President Clinton late Tuesday.

Marking a significant departure from attitudes that have governed the
treatment of opiate addicts for 86 years, the Drug Addiction Treatment Act
of 2000 permits qualified physicians to prescribe take-home doses of a mild
narcotic, buprenorphine, to people addicted to heroin or prescription
painkillers.

"It's revolutionary, I think, making it much more broadly available," said
Thomas Kosten, professor of psychiatry at Yale University's School of
Medicine. "It will help remove some of the stigma associated with opiate
dependence."

The Food and Drug Administration still must give the go-ahead on the use of
buprenorphine for treating narcotics addiction, but federal health
officials say this is expected any day.

"I've heard nothing from the FDA that would suggest this is not going to
happen," said H. Westley Clark, director of the U.S. Health and Human
Services Center for Substance Abuse Treatment. Clark said buprenorphine
could be on the market for use in opiate detoxification and maintenance as
soon as January.

Developed by the National Institute on Drug Abuse and Richmond-based
Reckitt Benckiser Pharmaceuticals Inc., buprenorphine is an alternative to
methadone, a proven treatment hindered by the fact that it is dispensed at
highly regulated clinics in daily doses.

Buprenorphine, a narcotic already used as an injectable painkiller, is
powerful enough to block the craving for heroin. But its unusual chemical
properties make it longer-lasting, less addictive and--because it does not
suppress breathing--less likely to trigger a fatal overdose than methadone
or other opiates.

"It's the kind of drug that, like methadone, prevents you from withdrawing,
but also prevents you from experiencing the euphoria you experience with
heroin," said Michael L. Fox, medical director of the chemical dependency
unit at St. Mary Mercy Hospital in Livonia, Mich.

Federal officials estimate that there are from 500,000 to 1 million heroin
addicts in the United States, but only about 200,000 in treatment. By
moving narcotics treatment away from government-sanctioned clinics, federal
health officials hope to reach heroin addicts in rural areas and
middle-class drug users who shy away from methadone clinics for fear of
being seen. The widespread use of buprenorphine could limit the spread of
methadone clinics and the battles that often flare in neighborhoods
whenever a new clinic is proposed.

Marketed under the brand names Subutex and Suboxone, the drug would be
available in tablets that addicts would place under their tongues. "My
biggest fear is there won't be sufficient funds for the people who are
addicted to be able to get this . . . anti-addictive medication," said Sen.
Carl M. Levin (D-Mich.), a sponsor of the bill. Though the cost of
buprenorphine isn't yet known, federal health officials already are
exploring ways to make it affordable, Clark said.

Charles P. O'Brien, chief of psychiatry at the Veterans Administration
Medical Center in Philadelphia, said the new law represents a major shift
in attitudes away from viewing addiction as a moral vice toward seeing it
as a chronic disease like diabetes.