ADDICTS' CURE HAS FATAL FLAW

BROCKTON -- Heroin addicts are lining up to pay hundreds of dollars a
week to Massachusetts doctors who refuse to accept medical insurance
for Suboxone, the FDA-approved drug that allows physicians to treat
opioid abuse in the privacy of their offices.

Some doctors are charging desperate addicts up to $3,000 for initial
visits -- and hundreds more for office visits lasting just a few
minutes -- before handing over a prescription for Suboxone, parents
and experts in the field said.

"There are doctors meeting people in parking lots, telling them, 'Go
to the back door of my house,' " said Colleen LaBelle, program
manager at Boston Medical Center's opioid treatment program. "It is
just abominable."

It is happening across the country.

The National Alliance of Advocates for Buprenorphine Treatment found
72 percent of patients were paying cash for treatment, with some
doctors complaining it was too hard to get reimbursed by insurance
companies. Buprenorphine is the active ingredient in Suboxone.

"The doctors say it is not worth the fight," said Timothy Lepak,
president of the alliance.

Suboxone, approved by the FDA in 2002, is the first approved
medication for opioid treatment in a doctor's office, and has been
heralded by some as a wonder drug for people addicted to prescription
painkillers and heroin.

Those treated with Suboxone take one to two tablets of the medication
daily to suppress withdrawal symptoms and reduce cravings. The pills
are placed under the tongue and dissolved.

Doctors can treat up to 100 Suboxone patients if they undergo an
eight-hour course offered by medical societies, get a waiver from the
Drug Enforcement Administration, and notify the government of their
plans. That number was increased from 30 per medical practice -- not
physician -- last December after complaints that there weren't enough
slots to treat the growing need.

About 150,000 people were treated with Suboxone in the country as of
August 2005, according to the makers of Suboxone, and the numbers are growing.

"Parents will pay anything to get their children help," said Joanne
Peterson, founder of Learn to Cope, a support group for parents of
opiate-addicted children.

But with the growth -- and hope the drug offers -- comes the
potential for greed, several said.

"There are a lot of shabby practices," Punyamurtula Kishore, a doctor
who specializes in drug treatment, said of some doctors. "They take
calls and they take the ones with the cash."

He said some of the doctors are making up to a half-million dollars a
year seeing patients who want Suboxone.

"When you are desperate, you do anything and people are desperate for
help," said Kishore.

One Braintree mother said her 20-year-old son paid $300 for his first
visit, $150 for the second and $75 each week to one doctor to get a
Suboxone prescription, even though he had Blue Cross/Blue Shield
medical insurance.

And when the family questioned the doctor about the treatment, she
said he got mad.

"He said, 'If you don't want the service and you don't want the drug,
you can go elsewhere,' " she said.

He wound up relapsing and his drug use escalated, she said. His
parents recently found him in the bathroom, overdosing on heroin.

"We spent $1,200 to do CPR on our son," his mother said. "It was a
very traumatic event."

Lepak, who heads the The National Alliance of Advocates for
Buprenorphine Treatment, said the cash-only policy by some doctors
casts a good drug in a bad light.

"It takes away the credibility of the treatment. It makes it seem
like it is something shady," Lepak said.

The doctors that do take insurance -- and insist on counseling --
often have long wait lists, parents say. There are also 15 clinics
in the state, including one at Boston Medical Center, that provide
Suboxone treatment. Another health center, The New Bedford Community
Health Center, is expected to receive a grant to also provide
Suboxone treatment.

It was the only health center in this area to apply for the money.

Chantel Nouvellon, a Waltham psychiatrist who accepts three different
forms of insurance for Suboxone treatment, said getting reimbursed
can take a long time, depending on the insurance, and some doctors
may not want to deal with the paperwork to get paid.

"For some insurances, sometimes you don't get paid for a year,"
Nouvellon, of Arlington, said.

Christine D'Eramo, formerly of Abington, tried Suboxone and was able
to stay clean for nearly a year before relapsing.

"I don't think it is a miracle pill," D'Eramo, who is now drug-free
again, said. "If you already want to get clean, it can help you. If
you don't want to get clean, you are going to use."

LaBelle said at Boston Medical Center, where she works, older addicts
who have been battling substance abuse for years appear to have the
most success with Suboxone.

"It is a great option. It doesn't work for everybody. It is a lot
more effective for those who are really done. It is not a medication
for someone who just wants to still get high."

She said some of the younger addicts may not be ready to get treatment yet.

"It is their parents that are the ones that are dragging them in by
the hair," LaBelle said.