COUNTERACTING HEROIN TAKES MANY FORMS

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Methadone, a synthetic opiate, is still largely considered the gold
standard for treating heroin addiction. It's a liquid dose of legal
relief that suppresses narcotic withdrawal for 24 to 36 hours.

"It's been more widely researched than the atom bomb," said Carmen
Arlt, director of chemical dependency and addiction for Porter-Starke
Services Inc. But a newer treatment option -- buprenorphine,
prescribed by doctors as Subutex and Suboxone -- has experts, field
workers, and even methadone patients excited about its possibilities.

"The advent of buprenorphine was truly a gift. Without a doubt it is
the biggest advance in treating opiate dependence since methadone,"
said Dr. S. Alex Stalcup, a national expert on heroin addiction and treatment.

Buprenorphine is the first medication treatment available through a
primary care physician. Since its launch in 2003, an estimated
200,000 Americans have taken it, including hundreds of local patients
through specially trained doctors.

The drug, sold by Reckitt Benckiser, is a generic term for Subutex,
given the first few days of treatment. Suboxone then combines
buprenorphine and naloxone, prescribed for treatment maintenance.

Arlt, who boasts three decades of experience in this field, said
buprenorphine is aimed at short-term opiate users, not longtime heroin addicts.

Timothy Lepak, cofounder of the National Alliance of Advocates for
Buprenorphine Treatment, said replacement therapies such as methadone
may save lives by keeping patients off more dangerous drugs. But
buprenorphine allows patients to "step out" of an addiction and avoid
a relapse.

Dr. Frank Vocci, director of the pharmacotherapies division for the
National Institute of Health, said being away from heroin for a year
or two does not decrease the craving for more.

"The desire for opiates can last for years," he said.

Although rapid detoxification and infamous "cold turkey" withdrawal
methods have poor success rates, buprenorphine allows users to slowly
and gradually taper their dose allowing the brain to adapt to a
drug-free status, Lepak said.

Stalcup, medical director of New Leaf Treatment Center in Contra
Costa County, Calif., began prescribing buprenorphine as early as
1992, "somewhat illegally," he said, adding he used it to treat pain,
referring to the pain of opiate withdrawal.

"It was a great relief when it became legal," he said.

"It is hard to get high on, and it is hard to overdose on."

These days, he travels the country training health professionals and
lecturing to communities with heroin-related issues, including Porter
County, which he visited in April.

During that visit, he told local health professionals that it takes a
users' brain chemistry about 40 years to return to normalcy from the
ultimate feel-good high of heroin addiction.

Whether users try methadone or buprenorphine to kick heroin, most
experts agree the best results include long-term counseling and
community residential programs for three to six months.

Dr. Sarz Maxwell, medical director of the Chicago Recovery Alliance,
said society is taught to only think of heroin addiction in moral or
legal terms.

"It's a big leap to think of it as a medical condition first," she said.

[Sidebar]

What Is Methadone?

Methadone first was introduced in 1947 as a pain-killing synthetic
opiate. In recent decades, it's been used to treat heroin addiction.
Also called methadose, it comes in small, premeasured, sealed plastic
cups. Some clients get 5 milligrams of the dark-colored,
smooth-tasting tonic, others get 160 mg. It all depends what they
need to get by until the next sunrise.

Sweet-N-Low Pack To Get High

It takes only 2 to 5 milligrams of heroin to get high. To get an idea
of how much this is, a single pack of Sweet-n-Low or Equal is 1 full
gram, according to Dr. Frank Vocci, director of the pharmacotherapies
division, National Institute of Health. Feedback Form Questions,
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