NEW TREATMENT OFFERS HOPE FOR HEROIN ADDICTS

Medication Safer Than Methadone

Nancy Foster prowled the streets of Boston, New York, and London for 23
years hunting for her next heroin injection.

She had tried methadone, the standard addiction treatment since the 1960s,
but didn't like the way it made her feel or the 30 pounds she packed on
while using it. Soon, she was back shooting heroin, a drug whose use has
reached epidemic levels nationally and in Massachusetts, where deaths from
the drug and related narcotics rose nearly fourfold in the 1990s.

But three weeks ago, Foster, who lives in Chinatown, began taking the
newest treatment designed to fight heroin addiction, a medication called
buprenorphine. Unlike methadone, it can be given in a family doctor's
office or even taken at home, and it is both safer and less likely to prove
addictive.

"I feel it's saved my life," said Foster, weeping in gratitude one recent
day in the office of her physician, Daniel Alford. "Before, all my time and
energy was devoted to getting money to buy heroin and to finding it. This
is a medication that can really help people."

Buprenorphine, which became available in this country last January, marks
the biggest advance in heroin treatment in decades, said federal drug
treatment authorities, who are touring the country to promote it. Speaking
at Boston University School of Medicine yesterday, representatives of the
Substance Abuse and Mental Health Services Administration encouraged
primary care physicians to undergo the required eight hours of training so
that they can treat patients with the new drug.

"Primary care physicians, because of their central role, are in a very good
position to both screen and treat individuals who have become addicted to
opiates," said Robert Lubran, director of the Division of Pharmacologic
Therapies at the US Center for Substance Abuse Treatment. "This new
medication literally changes the way we do business in this field."

It is a field that has exploded in the past decade.

A study issued in December by the Massachusetts Department of Public Health
found that heroin now ranks as the illegal drug of choice for patients
checking into rehab clinics, with 42 percent of patients who received
substance abuse treatment in 2002 reporting that they had used the drug
recently. That compares with just 19 percent a decade earlier.

The heroin surge, specialists said, is a classic case of street economics:
The drug is both purer and cheaper today, with a hit of heroin selling in
some neighborhoods for less than a six-pack of beer. And, unlike a decade
ago, when heroin was rejected by middle-class users as the province of
street junkies, today the drug is snorted and smoked, burnishing its appeal
in the suburbs.

At his practice in South Boston, Dr. Charles Brackett said he has
encountered middle-aged fathers hooked on heroin, as well as "an
18-year-old girl who looks like she just got off cheerleading practice who
has been snorting heroin for the last six months."

Until recently, health centers such as the one where Brackett treats
patients didn't have much of a role in helping heroin addicts kick their
habit. Instead, treatment fell almost exclusively to special methadone
clinics, where, federal regulators concluded 30 years ago, specialists
could more easily monitor the addictive treatment and prevent abuse.

In those clinics, patients get liquid doses of methadone to help control
their craving for heroin. But because addicts must go to special venues
designated for treatment, the clinics carry a stigma that keeps many away.
Plus, it is well known among users and the people who treat them that the
clinics often act as magnets for dealers, who lurk outside.

"Going to a methadone program to become free of addiction," Foster said,
"is like picking up insulin in a candy story."

Specialists estimate that fewer than 1 in 5 heroin addicts get the
treatment they need at a time when the nation has an estimated 1 million
heroin users and thousands more hooked on prescription pain killers such as
OxyContin. Both Foster and physicians stressed yesterday that they believe
methadone remains a viable treatment, especially for addicts with hard-core
habits. Several operators of methadone treatment programs who spoke at the
forum said they're interested in adding buprenorphine.

The new drug, used in Europe for a decade, comes in a tablet placed under
the tongue. It works in a fashion similar to methadone: It attaches to the
receptors in the brain that heroin burrows into, placing a cap on them so
that heroin can't get in. But it is slower-acting than methadone, meaning
withdrawal is less dramatic.

Because it is viewed as safer than methadone and less likely to result in a
patient substituting one addiction for another, federal authorities decided
to allow family physicians to prescribe it, Lubran said. Already, 59
doctors in Massachusetts have been given waivers allowing them to prescribe it.

Typically, patients beginning treatment will receive buprenorphine for one
or two weeks under the direct supervision of their doctor. Then, they begin
taking a hybrid form at home made with a second drug, naloxone. That second
medicine has no effect when taken orally but is present to prevent patients
from grinding up the medication and injecting it. If they do that, naloxone
causes wrenching withdrawal, an effect designed to dissuade further injection.

Because the heroin addiction treatment is so new, payment for the drug and
for doctor office visits is still being negotiated by private and public
health plans, although MassHealth, the state's health care program for the
poor, began paying for buprenorphine at the beginning of this month, Alford
said.

"We believe there is no silver bullet that is going to cure this problem,"
said Deborah Klein Walker, an associate commissioner for the state
Department of Public Health. "But we need all the options we can get."