LAW LIMITS ALTERNATIVE TREATMENT FOR ADDICTS

Calls For Wider Access To Drug Buprenorphine

At Boston Medical Center, about 500 people are on the waiting list for
buprenorphine, so many that the hospital has stopped taking names for those
seeking to sign up for the treatment for heroin and OxyContin addiction.

Codman Square Health Center in Dorchester fields calls from as far as
Gloucester, Cape Cod, and Western Massachusetts from addicts begging for
"bupe."

Fall River psychiatrist Claude Curran said he has prescribed the medication
to five times as many patients as the 30 he's allowed to by law, because
they just can't get it anywhere else.

"One couple came in here, and they had blown $44,000 on OxyContin in the
last six months," he said. "What do I do? I took a Hippocratic Oath. The
Board of Registration gives us a license thinking we will do our best to
treat people. I'm trying to do that."

When buprenorphine became available as a treatment for OxyContin and heroin
addiction 18 months ago, many medical professionals and addicts hailed it
as a miracle drug, bringing addicts back from the brink and helping them
lead normal lives when all else had failed.

But for many addicts, buprenorphine remains one of the hardest drugs to obtain.

Approved by the federal Food and Drug Administration in 2002, buprenorphine
is an opiate like heroin or the painkiller OxyContin. Unlike those drugs or
methadone, the prescribed drug it's meant to replace, buprenorphine doesn't
cloud the minds of patients, allowing them to work or study as if they're
not on any drug at all. Nearly all who take buprenorphine, meanwhile, say
they lose all physical cravings for street drugs.

But a combination of federal limits on the distribution of buprenorphine,
and reluctance on the part of some physicians to offer it to patients has
kept thousands of opiate addicts from receiving the drug in Massachusetts
and across the country. At the heart of the issue is federal legislation
passed in 2000 -- two years before the drug was approved by the FDA -- that
restricts individual clinical practices from treating more than 30 patients
with buprenorphine at a time.

While many substance-abuse experts say the 30-patient figure is too low for
some practices, their main quarrel with the Drug Addiction Treatment Act of
2000 is its failure to differentiate single-physician practices, hospitals,
and health care organizations. For example, all the doctors who work for
Tufts Health Plan can treat a combined 30 patients -- the same total as can
be seen by a physician practicing alone.

Boston health officials, along with their counterparts in the state and
federal governments, say the federal legislation erred on the side of
caution, and needs to be changed to allow wider access to buprenorphine.

"Boston Medical Center's main practice has 200 or more general
internal-medicine doctors, and within that practice, we can only treat 30
people. It's the craziest loophole," said Colleen Labelle, nurse-manager of
the hospital's Office-Based Opioid Treatment Program. "We get 20 calls a
day from across the state. People are begging, desperate to get treated,
who we can't treat."

The federal Substance Abuse and Mental Health Services Administration has
begun an internal process to increase the 30-patient cap. But because any
proposed change would be subject to the public-review process, approval
could take as long as two years, said Nick Reuter, a senior public health
analyst with the agency.

US Senator Edward M. Kennedy became a cosponsor two weeks ago of a bill
introduced last fall by US Senator Orrin Hatch, a Utah Republican, that
would lift the 30-patient limit. The legislation remains in committee.

With big HMOs and teaching hospitals unable to treat many addicts with
buprenorphine, the onus is on smaller practices. Unlike liquid methadone,
buprenorphine, which comes in pill form, doesn't have to be ingested at a
clinic under medical supervision. But many private physicians have resisted
the urgings of federal drug-treatment authorities and the state Department
of Public Health to prescribe the treatment.

Reuter said about 3,000 doctors nationwide have completed the necessary
eight hours of training for a license to prescribe buprenorphine, which has
been available in Europe for over 10 years. The goal is to have 6,000
licensed, he said.

Massachusetts has 167 doctors who are licensed, but for various reasons,
only half are prescribing buprenorphine, BMC's Labelle said.

Some doctors lack the ancillary staff, including counselors, nurses, or
social workers, to properly help opiate addicts in their recovery. Others
complain of delays over reimbursement from health insurers, or simply don't
prescribe buprenorphine, knowing it won't be a large part of their practice.

"Some physicians say, `If I can only take these 30 patients, why should I
bother at all?' We've heard that," Reuter said.

Many doctors are also fearful, Labelle said, of opening their doors to
addicts who traditionally were diverted to methadone clinics or
substance-abuse centers. "That can be something that's not appealing to a
primary-care setting," she said.

Moving drug treatment into the realm of private practices, however, is
exactly what the Drug Addiction Act of 2000 was created to do, said Dr.
Jonathan Pincus, of Dorchester's Codman center. "Part of the goal is to
decentralize and eliminate the stigma drug addicts face so they're not in
line at the methadone clinic," he said. "With buprenorphine, they're with
everyone else getting their medical problem treated."

According to the best estimates of health officials, there may be more than
60,000 heroin addicts in Massachusetts, in addition to those addicted to
painkillers. While the most serious long-term addicts, including the 12,000
who frequent clinics, are likely always to need methadone, many newer users
would almost always benefit from buprenorphine, Labelle said.

The number of people eligible to receive buprenorphine stands at about
2,000, she said.

Timothy Tigges says his addiction began after he wrenched his back and
bummed a few Percocet pills, a prescription analgesic, from a friend to
dull the pain. Before he knew it, he was hooked on opiates, alternating
between OxyContin and shooting up heroin as his life went to pieces.

In October, Tigges, a 27-year-old East Boston carpet installer, began
taking buprenorphine, placing an orange pill the size of a dime under his
tongue until it dissolves, four times daily. He hasn't touched an illegal
drug since the day he started the program, has put on 80 pounds from
lifting weights at the gym, and has yet to miss a day of work. For the
first time in three years, Tigges hopes to see his 5-year-old daughter,
whose mother has refused to let him visit.

"I've had clean urines, 100 percent, for nine months now. There's nothing
I'm prouder of than that," he said, choking back emotion. "What I read on
the front page of the paper every day is 18- and 20-year-old kids dying of
garbage drugs. There's just no need for it. I would take every ounce of
heroin off the street and give them this stuff. You watch the crime rate go
down."