GREATER ACCESS TO TREATMENT HAILED

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."