NEW MEDICINE EASES OPIATE DETOX

Drug Soothes Body So Users Can Focus On Psychology Of Addiction

PEORIA - The new drug buprenorphine promises to revolutionize the way those
addicted to heroin and other opiates can kick their addictions - if they
know about it and can afford it.

The medication, unlike current treatments, quickly eases withdrawal
symptoms for many patients. While detoxification is not life-threatening,
"it's very uncomfortable," said Tom Murphy, chief of operations at White
Oaks Companies, which operates drug and alcohol treatment centers in Peoria.

Detox effects include diarrhea, sweating, shaking, indigestion, nausea and
psychological paranoia. "It's terrifying and very difficult," he said,
adding that many people leave treatment because they cannot stand the
rigors of detoxification.

The new medication is coming at a good time, Murphy said. So far this year,
White Oaks has admitted 122 men and 84 women for opiate addictions. Last
year the number was about 168 for the entire year.

That increase follows a national trend. The federal Substance Abuse and
Mental Health Services Administration recently reported a

35 percent increase in heroin users treated in hospital emergency
departments since 1995, to more than 93,500 users.

Not everyone who could benefit from the new treatment is able to pay for it.

The Illinois Department of Alcohol and Substance Abuse pays White Oaks up
to $150 per day for inpatient rehabilitation for indigent, uninsured
patients, and also pays for outpatient counseling.

The inpatient cost includes medicine for some addictions, but the price of
buprenorphine, which typically totals about $400 per patient when the
necessary blood tests are included, is not factored into the daily cost,
Murphy said.

"As of now, there are no (state) funds for the drug," he said, unless the
person is covered by Medicaid.

If patients cannot come up with the money, through insurance or family
members, they cannot receive buprenorphine, he said.

White Oaks finds itself in a dilemma, Murphy said. "We want to give
everyone state-of-the-art treatment but cannot absorb the cost for the
indigent without (extra) financing. It's hard for us to see one person
getting it and another not. It's awful."

Since Aug. 1 alone, White Oaks has treated 22 men and 14 women addicted to
heroin or other opiates, he said. A minority are like Rush Limbaugh,
addicted to prescription opiate painkillers. Of the 22 men, 12 were not
able to pay for buprenorphine. The new drug was offered to the 10 men who
could pay; of those, four left after taking one dose, Murphy said.

"Some people respond immediately. Some don't," he said, adding that the
dosage must be adjusted. Patients must be in the early stages of painful
withdrawal before they begin the buprenorphine, he said, and some choose
not to undergo that experience, or to wait for results.

Four other men successfully completed the inpatient detox program and
continued in rehabilitation counseling, lasting up to 30 days or longer,
Murphy said. And three women lately have been in detox for heroin
addiction, Murphy said, adding that two of those received buprenorphine and
are doing well.

Two other men completed detox and left against medical advice, deciding not
to do rehab counseling, Murphy said.

That's a mistake, he said, adding that research shows that without
counseling, they are more likely to relapse.

Addiction

Research and clinical experience show that chemical addiction is a brain
disease, Murphy said. That means the brain is telling the addict to use the
chemical and ignore other signals. "That's the pain and difficulty with
addiction."

The chemicals help a person stop worrying about bad behavior, guilt and shame.

"It disinhibits you emotionally," he said. "It covers emotional pain that
would otherwise normally inhibit you. If you're doing something you think
is wrong, most chemicals (from alcohol to street drugs) help you say 'to
hell with it.'(0x2009)"

That's why addicts fight, say things they should not and hurt people they
love, he said.

Detox with buprenorphine for opiate addicts deprives the brain of most of
its "ammunition," Murphy said, and enables a person to choose something else.

Rehab counseling then helps the person gain the skills and insights to
prevent relapse and to recover, he said. These include refusal skills, new
social skills and new skills to deal with pain, both psychological or physical.

A Patient's Experience

"John," a 22-year-old man who asked that his real name be kept private,
said buprenorphine enabled him to change his life.

"It's a godsend," he said. "It's a wonder drug."

John is typical of the new heroin user, Murphy said, in that he's a young,
white, middle-class male who started using drugs as a teenager and
graduated from marijuana to harder drugs like cocaine and heroin.

After little more than two weeks of buprenorphine, John, interviewed at
White Oaks, said he feels fine and doesn't need heroin any more. "I'm
feeling normal. As each day passes I feel less craving, more energetic."

The drug "cures everything - craving, sweats, anxiety. No tremors, no
nausea. You can eat," he said.

Normal withdrawal is "like the flu times 10," he said, adding that he would
have left treatment if he had to experience it.

John said he dropped out of college and drew a paycheck from a family
business while his life imploded from heroin use. As he needed more and
more heroin simply to feel normal and avoid withdrawal, the costs mounted.

"I was stealing from my parents, my roommates. It's not like I didn't feel
remorse. You feel bad," but also will do anything to get the heroin, he said.

He bought heroin from a network of local dealers, but was never arrested.
However, he knew how risky his heroin addiction had become: He could have
gone to jail or died from an overdose or an impure supply. And he was to
the point of sampling a tiny portion of the heroin he bought on the street
to see whether he reacted badly to the sample.

Finally, he decided his life was unmanageable and entered treatment
voluntarily. "The drug overtook my life. I got sick and tired of wasting my
life and getting nowhere."

His parents supported his decision and paid for buprenorphine, he said.
"Without them, I would be on the streets."

Others in the White Oaks program who could not pay for the drug were
leaving treatment to escape withdrawal, he said. Of those who stayed, but
could not afford buprenorphine, "I saw them go through hell," he said.

New Medications

Buprenorphine and a combination of buprenorphine/naloxone are the first
medications approved by the Food and Drug Administration for office-based
treatment of opiate addiction. Naloxone is an opiate antagonist, prescribed
for long-term maintenance with buprenorphine.

Buprenorphine reduces or eliminates withdrawal symptoms but is not strong
enough to produce the euphoria and sedation caused by heroin and other
opiates, the National Institute on Drug Abuse says. So it is unlikely to be
abused.

The FDA requirements for use of the drug include: physicians must have
special training and certification to dispense the medications, must treat
no more than 30 patients at a time in an office setting, and must refer
patients for counseling.

Patients also can take the drug in a clinic setting, as John has done.
Murphy believes that's the most effective treatment method.

Buprenorphine administered in an office setting is expected to increase the
numbers of patients receiving treatment for opiate addiction, which
includes addiction to painkillers such as OxyContin, the NIDA has stated.

Nearly 1 million Americans are dependent on opiates, but only 200,000 are
getting treatment in licensed methadone clinics, the agency says.

Dr. George Shotick, a physician at White Oaks, said that in the Peoria
area, to his knowledge only he and another White Oaks physician, Dr. George
Gilbert, have undergone the required training.

Buprenorphine "will be used like methadone for long-term maintenance or
short-term detox, but the difference is it's safer and OK (for) doctors'
offices through certain pharmacies," he said.

Long-term maintenance is for those who fail to get off the drug, or who
don't succeed when they undergo detoxification, he said.

Researchers are searching for medications that also can treat other types
of hard-to-treat addictions for such street drugs as methamphetamines and
cocaine.

In Europe, an epilepsy drug, gamma-vinylGABA, also known as vigabatrin and
by the trade name Sabril has been used to treat cocaine addiction. It is
not approved for use in the United States, but researchers from the New
York University School of Medicine are testing it in Mexico, in a study
partly supported by federal funds.

Back at White Oaks, Murphy said the heroin addiction patients there, mostly
younger adults like John, come from throughout central Illinois and from
every cultural, socioeconomic and racial background.

"We need to get the message out. If they can afford the medication, we can
find places in rehab," Murphy said.

John said the heroin users he encountered had never heard of the new
medication.

"A lot of people who are ready to quit need to know about this," John said.
They "would seek help if they knew."