NEW DRUG GIVES ADDICTS A WAY OUT

Buprenorphine May Be A Key For Abusers Of Heroin, Painkillers

Odis Rivers was hooked on heroin for 20 years. He says he tried to stop a
thousand times without success.

Then he heard about a professor at Wayne State University who was offering
addicts a new way to quit: taking a new medication called buprenorphine.

Rivers signed up for the clinical trial in 1997. He hasn't used heroin
since. In 1999, he tapered off of buprenorphine and says he has been
drug-free for more than two years now.

Rivers has told his story to doctors, senators and countless family members
and friends. Today, he will tell it again at a public seminar in Detroit
organized by the federal Substance Abuse and Mental Health Services
Administration.

Rivers and federal experts say buprenorphine can be life-changing not only
for heroin addicts but also for the rapidly increasing numbers of people
abusing pain-killers, which can mimic heroin's effects on the brain.

"I was having big withdrawal symptoms. It eased all of those symptoms down,"
Rivers said last week. "That way, I was able to think clearly and make good
decisions. It turned my life around."

Rivers of Baltimore lived in Detroit until he finished the Wayne State study
two years ago.

The seminar, which begins at 9:30 a.m. at Coleman A. Young Municipal Center,
is the first in a series of similar events scheduled for 14 cities
nationwide. Their purpose is to educate patients, doctors and other
drug-treatment professionals about buprenorphine, which just reached
pharmacies in January.

Alternative to Methadone

The medication offers tens of thousands of addicts in Michigan -- and
millions across the country -- an alternative to methadone, which for three
decades has been the predominant choice, besides quitting cold turkey.

Dr. Vipul Patel, who works in a Henry Ford System substance-abuse clinic on
Maple Road in West Bloomfield, is one of 19 Michigan doctors who have
received government clearance to prescribe buprenorphine.

"I haven't had any chance to use it yet," he said last week. "But I want to
help my patients. I want to see if it's a better alternative."

U.S. Sen. Carl Levin, D-Mich., also will speak at the seminar, along with
federal officials and several local doctors and drug-treatment experts.
Levin sponsored a 2000 law that established the conditions under which
doctors can prescribe buprenorphine.

"Narcotics are such a huge drain on our community as well as our families,"
he said last week. "This opens up such great potential. It's an important
new weapon in the war on drugs."

Buprenorphine holds promise for addicts of opiate drugs, which include
heroin and many pain killers, such as darvon and codeine. For years, heroin
was the most-abused drug in the family. Recently, however, abuse of
pain-killers has soared as doctors focused more on pain control and
prescribed more painkilling drugs.

Now, the number of people abusing painkillers nationwide exceeds the number
who use heroin, according to the Substance Abuse and Mental Health Services
Administration. While heroin has the image of a "street" drug linked to
poverty and crime, painkilling drugs often are abused by middle-class people
with jobs and families.

Detroit ranks sixth among major U.S. cities tracked by the federal
government for abuse of painkillers, according to the substance abuse
administration. It ranks eight in heroin use.

Buprenorphine, sometimes called "bupe," has several advantages over
methadone for treating addiction to heroin or painkillers.

The primary advantage is that any doctor who goes through a day of special
training and registers with the government can write a prescription for
buprenorphine.

Methadone is heavily regulated and dispensed only from drug-abuse clinics
that require patients to stand in line daily and drink their dose in front
of a nurse.

Buprenorphine is a pill that can be taken as infrequently as once every
three days -- in the privacy of the addict's home. Currently, health
officials estimate that only 20 percent of heroin addicts are trying to quit
with methadone.

The percentage of painkiller addicts using methadone to try and kick their
habit is thought to be much smaller.

"It is so insensitive and stigmatizing that people have to go to a methadone
clinic," said Dr. Calvin Trent, director of the Detroit health department's
bureau of substance abuse. "It's really good that people will be able to get
this new medication from their family doctors."

Opiate Withdrawal

Both methadone and buprenorphine reduce or eliminate withdrawal symptoms and
craving for heroin or other opiates, such as painkillers. But users can
easily become hooked on methadone, taking the medication for many years.
Buprenorphine is easier to quit, according to doctors who have studied it.

Also, it's much harder to overdose on buprenorphine. In fact, if you try to
take a lot of it you won't get high because the medication has a "ceiling"
effect, said Robert Lubran, director, division of pharmacologic therapies of
the government's Substance Abuse and Mental Health Services Administration.

In fact, buprenorphine is commonly mixed with another medication that
actually will induce withdrawal symptoms if it is taken in
larger-than-prescribed doses.

Some drawbacks of buprenorphine, which is produced in the United Kingdom by
a conglomerate called Reckitt Benckiser, better known as the maker of
French's mustard and cleansers such as Lysol and Woolite:

* Buprenorphine costs about $10 a dose, compared to $3 a dose for
methadone.

* It's still not known the cost of the new medication will be covered by
Medicaid and various HMOs and insurance companies.

* Buprenorphine cannot help some people who now need very high doses of
methadone to reduce their drug cravings.

* It doesn't necessarily come with the psychological support and counseling
that is required at methadone clinics.

* It can kill patients who try to overdose on buprenorphine in combination
with other drugs such as alcohol.

"It's not a totally safe drug. I don't think any drug is totally safe,"
Lubran said. "It's another treatment option. We hope this is going to be the
new path to recovery."

Painkilling Treatment

Buprenorphine is itself a painkiller. It has been used to treat opiate
addiction for more than six years in France, during which time the number of
opiate-abusers there has fallen dramatically. Buprenorphine now is sold
throughout Europe for opiate treatment.

The Federal Drug Administration approved it for that use in the United
States last October.

The government plans to allow 6,000 doctors nationwide to prescribe
buprenorphine. Each will be permitted to prescribe the drug to no more than
30 patients at a time.

"We have many antibiotics," said Dr. Charles Schuster, director of Wayne
State's addiction research institute and the professor who helped Rivers and
about five dozen other heroin addicts quit using buprenorphine. "We need to
have more than one way to treat opiate addiction."

For more information about buprenorphine, go to
www.buprenorphine.samhsa.gov. For a list of other doctors who can prescribe
the medication, go to the www.samhsa.gov, click on Addiction Treatment, then
Office-based Treatment, then Physician Locator, then Michigan.