Overcoming addictions

December 18, 2007

It's disappointing - although not surprising - that a promising drug in the fight against addiction has become a sought-after narcotic in the illegal drug market in some areas of the U.S. and in other countries. As detailed in a series in The Sun that concludes today, buprenorphine is being abused by some patients and black marketeers, who sell it for profit or combine it with other drugs for a different kind of high.

This drug "diversion" is not unusual and is no reason to give up on "bupe," which has helped relieve addiction to heroin and prescription painkillers, such as OxyContin. A key solution is to put more safeguards in place, including more training for doctors and counseling for patients.

Buprenorphine helps take away the craving for heroin but doesn't require addicts to show up at a clinic each day, as they do with methadone. It can allow addicts to work productively and to reclaim their lives.

But in parts of New England and in France, as the Sun series shows, bupe has become its own drug of choice, a substitute of one opiate for another. Some doctors are prescribing it for short-term relief from early heroin withdrawal, when it is more appropriate as a long-term antidote to addiction.

Despite such misuses, bupe is still better than heroin and retains enormous potential to save lives. Baltimore's health commissioner, Dr. Joshua M. Sharfstein, insists that the version of the drug being used in approved treatment centers here is more difficult to subvert into other forms that can be injected, either by itself or in combination with other drugs. Even though addicts are introduced to bupe while in treatment so that they can be stabilized and monitored, many addicts continue to use heroin and other drugs, and others fear substituting one addictive substance for another.

Overcoming addiction can be a lengthy, complicated process, and doctors and patients could use more navigational help. Federal law requires doctors who prescribe bupe to take eight hours of training, but that may not be enough. The training requirements could be expanded, including more peer mentoring as the pool of doctors allowed to prescribe the drug increases. Similarly, more patient counseling should be provided, along with expanded support services.

Such improvements could go a long way toward enhancing bupe's effectiveness and realizing its promising potential to help thousands more addicts.

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