OPIATE ADDICTION DRUG EXPANDS REACH

For the first time, a drug for treating opiate dependence is available for
doctors to prescribe outside a clinic.

Now, as buprenorphine tablets head for pharmacy shelves, federal substance
abuse treatment experts are trying to line up docs for training so they can
treat growing legions of patients addicted to pain medications as well as
heroin.

"This will give more options to millions of people in need of treatment, and
it permits doctors to treat addiction just like any other medical
condition," said Charles Currie, head of the federal Substance Abuse and
Mental Health Services Administration.

According to the government's household survey on drug abuse, about 1.1
million people received treatment for an illicit drug problem at a specialty
facility last year. But another 5 million people who needed treatment didn't
get it. Of those, fewer than 1 in 10 felt they needed help and only about
100,000 reported they made an effort to get help.

Addiction experts have argued for decades that access to community treatment
clinics and residential treatment centers was too limited to meet the needs
of the population.

Methadone is the most common treatment for opiate addiction, mainly heroin.
But at best, 20 percent of addicts get this treatment, and it's not
available at all in four states. And experts say many people with addictions
won't go near a clinic for treatment, even if they recognize they have a
problem.

In addition to about a million chronic heroin users, more than 6.4 million
people reported using prescription pain medications for nonmedical purposes
last year.

For those addicted to heroin and pain pills, buprenorphine acts like
methadone. It affects the same brain receptors as morphine and other
heroin-like drugs. But once it's present in the brain, it blocks further
craving for heroin with a "heroin high."

"We actually sought out the manufacturer to use the drug for this purpose
because it showed a lower potential for abuse and a lower level of physical
dependence and side effects than other treatments," said Frank Vocci,
director of treatment research at the National Institute of Drug Abuse.

Experts at a news conference to promote the new treatment stressed that it
must be used in conjunction with counseling and psychological care.

"This is not a silver bullet, but it can open the door to recovery and
provide the opportunity to regain lost lives," Curie said.

The Food and Drug Administration approved two versions of the drug, sold by
Reckitt Pharmaceuticals, in October. One formula will include the
narcotic-neutralizing drug naloxone, the other tablet just buprenorphine.
Charles O'Keefe, U.S. president of Reckitt, said both versions would be
priced to cost about $10 a day.

The new treatment is the first to benefit from changes in federal drug laws
two years ago that allowed doctors to prescribe anti-opiate medications from
their offices rather than clinics, provided they get special training and a
waiver from the federal Drug Enforcement Administration.

"Now there are a lot of primary care doctors out there who might say, 'I
don't have anyone addicted to heroin among my patients.' But chances are
they've got patients who may be having a problem with dependence on pain
meds, and now they will be able to directly provide care to these patients
in their offices," said Dr. H. Westley Clark, director of the federal Center
for Substance Abuse Treatment.

Clark said beyond getting at least eight hours of specialized training in
the treatment and management of opiate-dependent patients, "I don't think
most doctors would find the record-keeping requirements any more burdensome
than they do existing DEA requirements for pain medications." The training
will be required only of doctors who don't already hold an addiction
treatment certification from one of several professional medication
organizations dedicated to addiction medicine or psychiatry.

As of late November, some 2,000 doctors had been trained around the country
and more than 1,000 had obtained DEA waivers to prescribe the drug. As a
further safeguard against abuse, however, no doctor will be allowed to
prescribe the drugs to more than 30 patients at any one time. The federal
addiction treatment organizations and professional treatment groups will be
holding special educational forums on the new drug in 14 cities around the
country starting next month. Training sessions for doctors in the region
will closely follow those forums.

On the Net: www.buprenorphine.samhsa.gov