CAUTION ON HEROIN BREAKTHROUGH

THE ARTICLE "New treatment offers hope for heroin addicts" (Page A1,
Aug. 12) describes buprenorphine as the biggest advance in heroin
treatment in decades. Believe me, I thought so, too. There is so much
about it that is positive: The addict doesn't have to feel like a
criminal anymore; he can simply get pills prescribed by his doctor.
The pill blocks his opiate receptors so he no longer craves heroin and
would actually get sick if he took it.

I have a friend who struggled with heroin addiction for more than 20
years. The last five he'd been doing much better: gainfully employed,
a volunteer for several community organizations, and worked out at the
gym every day.

In May, when we learned about buprenorphine, we thought we had found
the miracle of miracles. In July he died of an overdose.

On looking back, I wonder whether the pill made him feel and act so
normal that it was too normal for his own good. Maybe for a person
who's used to seeing the world with the rose-colored glasses of drugs
like heroin and methadone, going back into the same life without the
benefit of those rose-colored glasses, especially without special
counseling, is just too much.

Deadly overdoses are most common among recovering addicts who have
been clean for some time and then relapse. Their bodies are no longer
used to the heroin and are much more vulnerable to overdosing.

Yes, buprenorphine is a miracle drug -- probably the most positive
thing to come along in the recovery field. But expecting primary-care
physicians to "both screen and treat individuals who have become
addicted to opiates" after taking only eight hours of training and
then expect them to dispense the drug to people who have been
struggling for years with the most difficult of all addictions may be
heading for disaster. A person in recovery desperately needs intensive
professional counseling. Dropping a recovering addict back into life
without the support systems necessary is asking for tragic, needless
deaths.

Tobe f. Reichlin

Northampton