Doctors, drug users still wait on a prescription of promise

Shipping delays, stigma hinder pill's availability

January 15, 2003|By Jonathan Bor | Jonathan Bor,SUN STAFF

The long wait for buprenorphine, a prescription drug that is the nation's latest weapon against drug addiction, might soon be over. But for doctors and patients, the wait can't end soon enough.

Dr. Michael Hayes, a self-described "old hand" in the treatment of Baltimore's heroin addicts, wants to prescribe it for patients who would rather not stand in line for a daily dose of methadone.

In Ellicott City, Dr. David McDuff has fielded calls from suburban parents who are desperate to get their sons and daughters off drugs. And in Greenspring Station, Dr. Victor Ferrans is ready to prescribe it for patients who want to shake their addiction to heroin and the painkiller Oxycontin.

"Patients have been calling, well-to-do people," said Ferrans, an addictions psychiatrist. "And quite frankly, I'm a little desperate to get it for them."

They are among the small vanguard of doctors - 20 in Maryland and 616 nationwide - who have obtained the required license to prescribe buprenorphine, a tablet taken under the tongue that some addicts may prefer to methadone. But with hopes running high, doctors and public health experts have noted some roadblocks toward making the drug available to patients battling addiction.

First, though the manufacturer insists it has shipped supplies to pharmaceutical warehouses, local doctors and druggists have been unable to get it. Though this problem may prove short-lived, the wait has proved frustrating to doctors and patients who are eager to begin what could prove a new chapter in the treatment of addiction.

Second, perhaps more important, interest has run low among family doctors and other primary care physicians, the very group that government officials and public health advocates want to court. Without them, they say, there is little chance of realizing their goal of making addiction an illness that is treated like diabetes, heart disease and other chronic conditions.

Among the Maryland doctors whose names and telephone numbers turned up on a "physician locator" list posted on the internet by the U.S. Department of Health and Human Services, virtually all are doctors who already specialize in addiction. Many run methadone programs or offer psychiatric counseling to patients trying to shake their habits.

"We need to treat this much more as a health condition and bring this to the general medical world, decreasing the stigma," said Dr. Peter L. Beilenson, Baltimore health commissioner.

Dr. Robert Schwartz, an addictions specialist who sits on the board of the Baltimore Substance Abuse Systems, says he is confident that the drug will enter general practice once news of its promise spreads.

He and other board members are stirring interest among the 10 community health centers that serve indigent patients in Baltimore, Schwartz said. Among them are clinics that serve AIDS patients and the homeless.

Buprenorphine was released after nearly two decades of research, much of it conducted at the Johns Hopkins Bayview Medical Center. In 2000, President Bill Clinton signed into law a measure that allowed doctors to prescribe buprenorphine in their offices. While the signing ignited a flurry of media attention, the U.S. Food and Drug Administration had to approve the drug before it could be prescribed. That took nearly two years; the FDA approved the drug in October.

Only last week did the manufacturer, the Richmond, Va.-based Reckitt Benckiser Pharmaceuticals Inc., notify drug wholesalers that the medication was available. Charles O'Keeffe, the company president, said that most wholesalers in Maryland should have the drug in their warehouses within days. At that point, pharmacies should have no trouble ordering it.

For years, some drug treatment programs have quietly given patients short courses of buprenorphine to detoxify them from heroin. Though the medication was legal as a painkiller, its "off-label" use for drug addiction was technically illegal. One clinic in Montgomery County was briefly shut down by the Drug Enforcement Administration after a news article publicized its use of the drug.

Leslie Williams, a 34-year-old mother of three who lives in Baltimore, is eager to get a prescription and has been searching for a doctor who could write her one.

A heroin addict for five years, she received a five-day course of buprenorphine a few years ago in a detox program. The drug had made her feel normal for a short time, taking away her desire for heroin or the sick feeling she got when she needed a fix. But once treatment ended, her cravings returned and she started using heroin again.

Since then, she wondered why she couldn't take buprenorphine on a continuing basis, just as a diabetic would take insulin.

"I'm at the point where I'm not doing heroin to get high, I'm doing it to maintain," she said. "I want to be able to wake up in the morning and not have to worry about getting something just to maintain myself."

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