THERAPIES: FOR ADDICTION, A CHANGE OF VENUE

A new drug and changes in federal regulations should help move treatment of
heroin addiction out of methadone centers and into doctors' offices, the
author of an article being published today in The Annals of Internal
Medicine says.

Fewer than a quarter of the nation's estimated 800,000 heroin addicts are
believed to receive treatment, according to the article by Dr. David A.
Fiellin of the Yale School of Medicine. Many treatment centers have long
waiting lists, and many addicts, especially those still with jobs and
families, wish to avoid the stigma associated with drug treatment centers,
Dr. Fiellin said in an interview.

Five years ago, a federal panel concluded that treatment with an opioid
agonist - a drug like methadone that undercuts the euphoric effort without
bringing on withdrawal symptoms - could be effective when combined with
counseling. Since then, efforts have been made to make such care more
accessible, Dr. Fiellin said.

He said the biggest step was the approval last week by the Food and Drug
Administration of a new partial agonist, buprenorphine, which studies have
shown to be almost as effective in preventing relapse as methadone.

Buprenorphine has some clear advantages, Dr. Fiellin said. It is less
mood-altering, and when combined with an opioid blocker it is harder to
abuse. That has let it qualify for a less restrictive category of
controlled substances, he said, opening it to office use by trained
physicians. "Our expectation is that it will increase access to treatment
for a large population of patients," he added.

Other changes in federal regulations are beginning to make it possible for
physicians working in partnership with drug programs to treat stable
methadone patients in regular medical offices.

Dr. Fiellin said studies had shown that office treatment was as effective
as methadone clinics for stable patients and was more satisfying. They
"felt that they were finally being recognized for their stability, by being
able to receive their treatment in a more medical setting," he said.