NEW OPTION TO WEAN OFF HEROIN

City Seeks To Streamline Therapy, Lure Thousands To Detox By 2010
With Buprenorphine Off Heroin

In an unusual move, city Health Department officials are quietly
encouraging physicians, hospitals, methadone clinics and prisons to
prescribe the drug buprenorphine to heroin addicts, believing it will
lure more addicts into treatment.

Buprenorphine - a relatively new drug that goes by the nickname
"bupe" and comes in a pill form - offers a new set of treatment
options for opiate abusers, said Dr. Lloyd Sederer, executive deputy
commissioner of the city Department of Health and Mental Hygiene.

Fewer Side Effects

Chemically, the drug partially blocks the same brain receptors that
heroin and methadone target. But unlike those drugs, it doesn't
produce the same "high" or level of dependence. In addition,
withdrawal from buprenorphine produces less severe symptoms and fewer
drug cravings.

"The new medicine works differently in two ways," Sederer said. "Bupe
has a ceiling effect and reaches a certain point where it doesn't get
you higher, so it is much less likely to be abused or sold on the
streets. With heroin and methadone, the more you take, the higher you
get, and your lung function is depressed. The respiratory failure is
what results in death."

Methadone has been the standard for heroin addiction treatment since
the early 1970s. But the syrupy, amber liquid is highly habit-forming
and by law must be distributed - one dose at a time - at a special
clinic. That stricture causes some who would seek treatment to shy away.

"People say that methadone leaves them punchy, and they have
difficulty thinking and working," Sederer said. "The long-term data
on people in methadone programs shows that they are more stable, not
involved in crime, and that's a good thing, but only a small
percentage are working [in jobs]."

Relatively New Drug

Despite the potential benefits of buprenorphine, the drug remains
virtually unknown and unused by the city's heroin addicts. According
to city health officials, only about 1,000 people use it, compared
with an estimated 34,000 taking methadone.

Sederer and other city health officials want to see a significant
change in those numbers. The goal is to have more than 100,000 opiate
addicts using buprenorphine for detox maintenance by 2010.

"We are not reaching enough people with the treatments that we have,"
Sederer said. "Not everybody should be on methadone."

Like methadone, buprenorphine is heavily regulated, and may be
prescribed only by certified doctors, of which there currently are
345 statewide. In addition, those prescribing the drug are bound by a
30-patient limit, a federal restriction guarding against prescription
abuse that Sederer and other health officials hope will be changed so
that more patients can be treated.

Some private doctors have been reluctant to prescribe the drug,
fearing their offices would be inundated with addicts. The drug's
pill form would be more attractive to white-collar users trying to
avoid methadone clinics, experts said.

Somewhat complicating the picture, there are varying camps in the
medical community about how to treat opiate addiction. Some,
including Phoenix House, the country's largest drug-free residential
rehabilitation program, use bupe for detoxification; other programs
use it solely as a maintenance drug to replace methadone.

Dr. Terry Horton, the medical director of Phoenix House in the city,
calls buprenorphine "the most significant development in the
treatment of opiate addiction in 40 years."

"But," Horton noted, "it is not a replacement for methadone but
should be considered another tool we can use to treat opiate addiction."

Could Streamline Treatment

The goal, drug treatment experts said, is for more doctors to be able
to prescribe buprenorphine and for patients to be able to pick it up
at the pharmacy.

Potentially, thousands of people could benefit from the drug. The
city spends $50 million annually on treatment of an estimated 200,000
heroin addicts and 200,000 others addicted to prescription
painkillers like Vicodin, Percocet and OxyContin. The state Office of
Alcoholism and Substance Abuse Services will spend $313.7 million in
2005-06 to treat those battling against alcohol and other
drug-related addictions, spokeswoman Jennifer Farrell said.

"Buprenorphine expands the availability of treatment for those who
are addicted to opiates and allows recovering addicts to more likely
follow treatment to completion," Farrell said.

Opiate addicts on buprenorphine for maintenance have a better chance
of working because it has fewer side effects than methadone, Sederer
said. Also, having more opiate addicts in recovery would reduce crime
and the spread of HIV and other diseases related to needle use, he said.

Critics Seek Sobriety

City Council Member Margarita Lopez (D-Manhattan), chairwoman of the
council's Mental Health, Mental Retardation, Alcoholism, Drug Abuse
and Disability Services Committee, said substituting buprenorphine
for methadone isn't a solution.

"We have to deal with the underlying problems that lead a person to
substance abuse in the first place," Lopez said.

"It is a drug that is better than methadone, but the patients are
still on drugs and their performance is affected," Lopez said. "Our
ultimate goal should be for them to be clean and sober."

How They Compare

Methadone

In use since the 1970s

Habit-forming but considered less harmful than heroin

Users complain of feeling high and not feeling themselves, and of
withdrawal symptoms.

Nickname: "Meth"

Appearance: Amber, syrupy liquid

Users in city: An estimated 34,000

Availability: Usually obtained at special methadone clinics, a single
liquid dose at a time

Buprenorphine

Approved by Food and Drug Administration in 2002

Habit-forming but considered less harmful than heroin

Users say they have fewer cravings and less severe withdrawal symptoms.

Nickname: "Bupe"

Appearance: Orange-colored, hexagon-shaped pill

Users in city: An estimated 1,000

Availability: Obtained at special methadone clinics and through
certified, private doctors. Goal is for it to be picked up at a
pharmacy like any other prescription.

200,000 Estimated heroin addicts in the city