ADDICTS HAVE MORE OPTIONS

Patients can now use buprenorphine to kick their heroin and
OxyContin addictions in private.

Beth Worthy had a loving husband and two small children at home, yet
she found herself in the middle of a rundown apartment complex,
knocking on the door of a dealer who could give her the pain
medication she so desperately craved.

"I remember my heart beating and the rush to get up the elevator," the
31-year-old said. "It was scary."

Indeed, Worthy's life was scary.

Her path to addiction started innocently with a visit to her doctor
for chronic migraine headaches. He prescribed Vicodan. He also gave
her Darvocet and Percocet.

Before she knew what was happening, she was hooked.

"If I didn't have them, I didn't get through the day," she said.
"OxyContin, morphine, you name it, any kind of narcotic painkiller; I
had it."

Her life became all about the drugs. She stole from her father-in-law
and took out cash advances on the family's credit cards.

"It's an awful life," she said. "The only time I was happy was when I
swallowed those pills, and I got that sweet reward for two hours."

From suburban housewives in Pennsylvania to celebrities such as
syndicated radio talk show host Rush Limbaugh, white middle-to
upper-class Americans are turning to potent painkillers to make it
through the day.

For many people, becoming dependent on prescription narcotics is easy,
but getting off is another matter.

A new drug, buprenorphine, offers opiate addicts -- such as Worthy and
Limbaugh -- a chance to get their lives back.

Buprenorphine

Buprenorphine has been used successfully to treat heroin and opiate
addicts in France for years.

Recently, the drug became available in the United States as a way to
treat addicts in a doctor's office.

Until now, addicts had few options available to them.

They could try to quit on their own and go through withdrawal. They
could try detoxification or rehabilitation, or they could seek
methadone therapy. Those seeking methadone treatment, generally, must
go to a clinic every day.

The U.S. National Institutes of Health entered into a cooperative
research agreement with the British manufacturer, Reckitt Benckiser,
in an effort to make the treatment available in the United States,
said Charles O'Keeffe, president and chief executive officer of
Reckitt Benckiser Pharmaceuticals.

The U.S. Food and Drug Administration approved the drug in October
2002, and doctors nationwide began prescribing the new drug this year.

Neither the company nor the government can estimate how many people
will seek the new treatment. O'Keeffe's does not expect his company
will make a lot of money from the new drug either, he said.

But making a lot of money from the drug is not the pharmaceutical
company's main goal.

"This is the right thing to do," O'Keeffe said.

How It Works

The new buprenorphine treatment comes in two forms.

The first is a straight singular version of the drug, which is
marketed under the name Subutex. The second is a combination of
buprenorphine and naloxone, which is marketed under the name Suboxone.

Both Subutex and Suboxone reduce the symptoms of opiate dependence.
The naloxone in Suboxone makes the misuse of the drug less likely
because people will not get the desired euphoric effect.

Basically, the buprenorphine in both drugs hits the opiate receptors
in the brain, which satisfies an addict's need for narcotics. At the
same time, the buprenorphine blocks the brain's opiate receptors.

This means people taking Subutex or Suboxone won't feel the euphoria
or the high that they might experience on heroin, OxyContin and methadone.

"The addiction potential is less than with methadone," said Dr. Todd
Muneses, one of five doctors in York County who is registered to
prescribe the drug.

Overdoses also are less common with buprenorphine than with other
opiate-replacement therapies.

That is the reason the FDA approved the drug so that it could be
prescribed at a doctor's office as opposed to a clinic, where controls
are tighter.

That also makes buprenorphine treatment an attractive option for
people who can't beat their addiction on their own or do not want to
make daily trips to a methadone clinic.

The new therapy is making the treatment of opioid addiction a lot like
treating diabetes, Muneses said.

Muneses, a psychiatrist with WellSpan Behavioral Health, received the
U.S. Drug Enforcement Administration's approval to prescribe the new
drug in October.

He prescribes the drug therapy to five patients in his Hopewell
Township office, all of whom have private insurance.

The drug can cost anywhere from $90 to $200 for a month's supply of
pills.

Medicaid covers the cost of the drug should lower-income patients
desire the new treatment, according to the Pennsylvania Department of
Public Welfare.

Shortage of Doctors

Despite the potential benefits of the new therapy, few doctors
statewide and nationally have decided to offer the treatment.

Statewide, 99 Pennsylvania doctors are registered to prescribe the
drug, according to the federal Substance Abuse and Mental Health
Administration.

As of Oct. 1, 1,875 doctors nationwide had registered with the
DEA.

Worthy had tried rapid detox and had contemplated methadone treatment.
Then she found Dr. Sam Rice in Lancaster, who was able to treat her
with buprenorphine.

She called and was placed on a waiting list. Under federal guidelines,
doctors can only take on 30 buprenorphine patients at a time.

"I had to keep buying pills off the street until I could be seen by
this doctor," Worthy said. "As soon as someone was released, I was the
next person. Finally, I got the call to go to Dr. Rice's office."

On May 15, Worthy made the two-hour trip from her home in Rockhill
Furnace, near Huntington, to Rice's Lancaster office.

The lengthy road trip was worth it.

"You feel normal," she said. "This medicine that I'm on today does not
get you high. I am so thankful."

Signing Up More Doctors

An effort is under way nationally to get more doctors, mainly family
doctors, registered to prescribe the new therapy.

Dr. Dan Alford, a Boston doctor, prescribes buprenorphine in his own
practice. He also helps train other doctors on how to use the new therapy.

"The ultimate goal is to make this medication available in regular
medical settings," he said. "I think the initial interest was among
substance abuse providers and psychiatrists. We're starting to see
more primary care physicians coming to training."

Some family doctors might shy away from treating heroin and OxyContin
addicts, believing the experience might be negative. Alford has found
the opposite to be true.

"From my own experience, they are the most appreciative and enjoyable
patients to treat," he said. "They feel so much better on the
medication. Most of my patients have either gone back to school or
back to work. I actually look forward to seeing buprenorphine patients."

Most doctors, Alford said, can take an eight-hour course that will
qualify them for the necessary DEA registration to prescribe the drug.

Doctors can even take the courses online, Alford said.

Fortunately for Worthy, her family doctor got the necessary training
to prescribe the drug from his office.

She no longer has to make the two-hour trip to Lancaster once a
month.

That gives her more time to make up for the five years she lost with
her two children and her husband because she was high on
painkillers.

"There's no price for that," she said. "I could work, but I missed so
much of their life. It's time for them to have their mom. I did love
them, and I did want to be the normal mom."