MEDICINE OR MENACE?

No one likes to see people suffer chronic pain, much less the horror of
heroin addiction. But methadone, the medicine commonly prescribed for both
maladies, is looking more and more like a menace. The same could be said for
its expected pharmaceutical successor, buprenorphine.

People are overdosing on methadone in record numbers. Nearly 11,000 people
appeared in emergency rooms following methadone overdoses in 2001, double
the number from 1999, according to the federal Drug Abuse Warning Network.
The East Coast in particular appears to be suffering a rash of methadone
overdoses. In North Carolina, methadone-related deaths jumped from seven in
1997 to 58 in 2001; in Florida, they increased from 209 in 2000 to 357 in
2001; and in Maine, they jumped from four in 1997 to 18 in merely the first
six months of 2001.

The increases might be related to a loosening of federal guidelines in 2001,
which allow substance abusers who already have earned a sufficient level of
trust while in treatment to take home up to 31 days of methadone doses.
However, the drug is much more easily procured as a prescription painkiller.
When methadone is prescribed as a painkiller, the doses are higher since the
drug's ability to numb pain is smaller than its ability to reduce heroin
cravings. Not only are such people receiving more potent doses, but they are
also receiving more of them - methadone prescriptions for pain relief
normally last 31 days. They also are put under far fewer restrictions than
those who receive methadone at drug-treatment centers.

Moreover, while most general practitioners probably have a heightened
awareness of the need to relieve chronic pain (doctors have even been taken
to court for failing to do so), far fewer of them have the same awareness of
signs of addiction. Doctors pledged to treating pain appear to be between
the same two fires as those dedicated to treating heroin addiction - to
control protracted, debilitating conditions, they prescribe substances with
terrible potential for abuse.

Nor is the advent of buprenorphine, another methadone analog, likely to
change the situation. While like methadone, buprenorphine is less addictive
then heroin and can help reduce cravings, it is also sold as a painkiller.
Used in combination with other drugs - as addicts often do - buprenorphine
can also be a killer.

Buprenorphine will be as easily accessible as methadone, since to prescribe
it, doctors will have to complete only eight hours of training, and only
have the authority to refer patients into counseling programs. Some 2,000
U.S. doctors have already completed such training.

America's experience with buprenorphine seems likely to parallel that of
France, where buprenorphine has been used to treat heroin abuse since the
mid-1990s. While heroin-related deaths have decreased exponentially since
then, more than 150 buprenorphine-related deaths have occurred. In addition,
there has been doctor shopping for buprenorphine and illicit sales of it.

Methadone and buprenorphine must not be confused with true cures for either
chronic pain or heroin addiction. They are, at best, highly dangerous
chemical crutches. Judging by the ongoing steep increases in overdoses,
methadone appears to be as much a menace as a medicine.