PELLET FIGHTS CRAVING

Heroin Addicts Are Getting Help

The small pellet, about the size of a pencil eraser, was inserted
under the skin of the man's lower abdomen through an incision about an
inch long.

It was the final day of a three-day outpatient-detoxification program.
The man wanted to beat a $130-a-day heroin habit that was driving him
and his family into financial ruin.

On the first two days, he was given a powerful cocktail of drugs that
helped his body deal with withdrawal symptoms. The pellet, the next
step, would dissolve slowly, releasing Naltrexone, a drug that blocks
the ability to get high from drugs like heroin.

So even if the man got the urge to go back to using, he would not get
the usual pleasurable high.

Two months after the $2,900 accelerated-detoxification program, the
man, who asked that his name not be used, was on his second six-week
pellet and still drug-free.

The man traveled from out of town to Richmond for the treatment,
offered by Dr. Peter R. Coleman, a family doctor who also specializes
in addiction treatment at his West End practice. During treatment, the
patient and his wife spent nights at a local hotel, returning to
Coleman's office daily.

"I didn't realize how much I was missing until two or three weeks
after I stopped," said the 38-year-old man.

"It was like waking up from a bad dream. I had just neglected
everything for months, my kids, my bills."

The treatment is not cheap, but for patients struggling and at risk of
losing much more, it is worth it. The man in question had a
professional job making more than $80,000 a year and was married with
two young children. Heroin had drained him.

"I could not thank my parents more for putting up the money for it,"
he said.

Opiate addiction, said Dr. James May, "is the biggest single problem
with our adult treatment population." May is a practitioner in the
public sector, where dollars for treating substance abuse are
stretched thin. For about five years now, May said, heroin and other
opiate drugs have been the street drugs of choice.

"If you go back 10 to 15 years, cocaine and crack cocaine were the
dominant drugs of abuse. Now it's heroin," said May, of the Richmond
Behavioral Health Authority, which provides mental health and
substance-abuse services and case management for poor and low-income
people in Richmond.

Among hard street drugs, cocaine is still king, with an estimated 2
million users in 2002, according to data in the 2002 National Survey
on Drug Use and Health. The survey, conducted by the federal office of
Substance Abuse and Mental Health Services Administration, noted,
however, that in the latter half of the 1990s, the number of new
heroin users - more than 100,000 annually - grew to a level not
reached since the 1970s when an estimated 246,000 "new users" tried
heroin for the first time.

That compares to 1988 and 1994, when the annual number of new heroin
users ranged from 28,000 to 80,000. In 1974, there were an estimated
246,000 new heroin users. Opiate addicts are also among the estimated
6.2 million people currently abusing prescription drugs.

The impact of heroin's resurgence is being seen in the mix of
treatment services available and the demand for those services.

At the Richmond Behavioral Health Authority, where overall funding was
reduced last year, a bigger share of the agency's treatment money is
being spent helping heroin addicts.

"Our expenditures for methadone services are almost double what they
were five years ago," May said.

Methadone, a controlled substance, is a longer-acting opiate
prescribed to heroin addicts to alleviate cravings for heroin.
Patients in methadone programs are usually required to make daily
visits to clinics to get the medication. That requirement can be a
hassle for anyone with a job or who doesn't live near a clinic.

May said the authority is meeting patient demand by taking money from
other areas to put to methadone services. Also, patients are just
having to wait longer.

"From my review . . . you can have people waiting for services for six
to eight months," said May. "Our waiting list for services has increased."

In Virginia, about 4,600 to 5,000 people are enrolled in publicly
funded methadone clinics, but state officials have estimated the
number of people addicted to heroin and other opiates to be 10 times
that number.

There has been muted excitement in addiction treatment about the
impact another drug, buprenorphine, could have on opiate addiction
treatment. Buprenorphine is another drug that blocks the pleasurable
effects of opiates. Federal officials last year approved the drug for
treating opiate addiction. Doctors who have met certain training
requirements are able to prescribe the drug from their private practices.

"We have to offer more options," said Dr. George Bright, an addiction
specialist in practice at the Adolescent Health Center in Midlothian.
His office was part of buprenorphine clinical trials.

"That is why this office-based treatment is critical. We can't just
lock them up and throw away the key," Bright said.

Drug-seeking behavior, May explained, is at the root of a lot of
crime. There are some fairly large national studies, he said, that
show when drug addicts are in active addiction they commit lots of
property crimes.

"When you get those people clean, you see the reduction in crimes they
committed, seven-to 11-fold," he said.

Bright, who offers an office-based buprenorphine-based treatment for
opiate addiction, said unfortunately there is no rush of doctors to
offer addiction treatment.

"I don't think doctors are interested in taking care of this
population," he said.

In his experience, buprenorphine treatment is successful "in those
individuals who are truly interested in a comprehensive program that
involves both maintenance and counseling." In other words, it is not
magic, but takes work.

This month, Bright will begin clinical studies of a once-a-month
injectable form of Naltrexone. The study will enroll 20 to 50 people.
There is no shortage of patients wanting to participate.

"We have what we need. We have more than what we need," Bright
said.

Coleman's practice was busy on the day the 38-year-old got his
Naltrexone implant. There are several patients in different stages of
detoxification or recovery waiting to see Coleman. His office offers
various detoxification protocols.

In the past, heroin detoxification was not as hard, said
Coleman.

"The heroin was 5 percent pure. Now it's 50 to 60 percent pure. The
stuff that is out there is incredibly strong."

One of Coleman's clients is trying to get off the methadone he was put
on to get off heroin. Another client is a woman, a mother of three
school-age children. She went through Coleman's accelerated-detoxification
program three weeks ago. It's not just illegal street opiates that are
a problem. She was hooked on prescription medication prescribed for
neck and back pain.

"I chose it because it wasn't a narcotic," she said. "It wasn't
supposed to be addictive. . . . It kept me going. I was super mom."

When she tried to go without the drug, she felt miserable, physically
and mentally. When she tried to call in her own prescription, she was
caught.

"I was buying it off the Internet," she said. "I don't know how I ever
got to that point. I still don't."