Doctors will be able to start prescribing buprenorphine, a new treatment for heroin addiction, in the privacy of their offices when the medication reaches pharmacies next month, federal officials said yesterday.
Unveiling a national campaign to educate doctors and patients, officials said the treatment should enable thousands of addicts who do not want to go to methadone clinics - or who cannot get into the crowded programs - to set out on the road to recovery.
"This major advancement in substance abuse treatment will provide more options to people in need of drug treatment," said Charles G. Curie, administrator of the federal Substance Abuse and Mental Health Services Administration.
"It permits doctors to treat addiction to heroin or other opioids, including prescription painkillers, just like any other medical condition, such as diabetes or hypertension," Curie said.
Congress passed a law two years ago that enabled doctors to prescribe buprenorphine tablets in their offices after taking an eight-hour training course. But it took another two years for the U.S. Food and Drug Administration to approve its use, doing so in October.
Odis Rivers, a recovering heroin addict who lives in Baltimore, stepped forward at a news briefing yesterday to say that the medication enabled him to quit using heroin after 32 years. His habit had ruined two marriages and estranged him from his children.
He said he entered "detox" programs numerous times but kept reverting to heroin when the craving became unbearable. He was afraid to try methadone because he had heard too many stories, which he now regards as untrue, that the drug was harmful.
In 1998, Rivers heard from another addict who had enrolled in a clinical trial in Detroit that buprenophine had helped her kick heroin. That year, Rivers enrolled, too, and said he has been off heroin ever since.
"I was able to start using my head and think and make good decisions," he said. "I started feeling a lot better and more relaxed. This is something that can help addicts become responsible persons."
He added, "There is no way you can just stop all by yourself."
With his doctor's guidance, Rivers began tapering his dosage two years ago and soon was able to stop taking it altogether. He says he hasn't relapsed into heroin use, though he attends a 12-step program to stay in recovery.
Dr. Frank Vocci, director of treatment and research at the National Institute on Drug Abuse, said many addicts might have to stay on buprenorphine indefinitely. The goal, he said, isn't necessarily to stop treatment - it's to stay off heroin.
"The ultimate point is to get people to manage [addiction] and understand it as a chronic relapsing disorder," he said.
Availability of buprenorphine comes as Maryland is experiencing a steady increase in overdose deaths resulting from the use of heroin, alcohol and other drugs. Yesterday, the University of Maryland, College Park reported that overdoses killed 559 people last year, a 16 percent increase over 1997.
More than four-fifths of the fatalities were caused by overdoses of heroin, either singly or in combination with other drugs.
Originally tested as a pain medication, buprenorphine was studied for more than 15 years as a potential treatment for addiction at the National Institute on Drug Abuse in Baltimore and at the Johns Hopkins Bayview Medical Center.
The tablet works by satisfying an addict's craving for opioids - a family of drugs that includes heroin, morphine and codeine - without producing a "high." In some cases, it has the added benefit of making a patient sick with withdrawal-like symptoms if the person decides to use narcotics again.
Doctors have the option of prescribing a buprenorphine-only tablet or a tablet that combines buprenorphine and naloxone, a formulation that is designed to prevent abuse. If someone dissolved the latter form of the medication and injected it, an addict would experience intense withdrawal symptoms, according to researchers.
Buprenorphine isn't necessarily more effective than methadone in helping people kick a heroin habit but might be more palatable to addicts who fear the loss of privacy that might come with attending a methadone clinic on a daily basis, researchers say. Addiction specialists hope it will take the pressure off methadone clinics, which generally are full and have long waiting lists.
Also, in rural areas, some people have to drive hundreds of miles to reach the nearest methadone clinic.
About 2,000 doctors have taken the necessary training to prescribe buprenorphine, not nearly enough to serve the millions of people who need treatment. In Maryland, about 35 doctors have been trained.
The federal government plans to expand the number of qualified physicians by holding training sessions in 14 cities, including Baltimore, in the coming year.