New Drug Promises Shift in Treatment for Heroin Addicts

A newly approved substitute for methadone -- the standard for treating heroin addiction since the 1960s -- is generating enthusiastic praise from both experts and addicts, and it could triple the number of people in serious treatment for heroin addiction.

For many addicts, though not all, buprenorphine functions like methadone, blocking the craving for a high, but experts and addicts point to several advantages it has over the older drug -- the most important may be that a patient can get a supply, rather than just a dose, with a visit to a doctor and pharmacy. For many addicts, not having to go to a methadone clinic daily is an enormous advantage.

Like methadone, buprenorphine is addictive, but with a much lower risk of overdose. And unlike methadone, buprenorphine will not give an addict more than a mild high regardless of how large a dose given, and it cannot be combined with opiates or other narcotics to get higher still. Users report fewer unpleasant side effects and milder withdrawal symptoms upon discontinuing its use.

"My hope and my expectation is that buprenorphine will revolutionize heroin treatment in the United States," said Dr. Herbert D. Kleber, a professor at Columbia University's College of Physicians and Surgeons and a leading expert on heroin and buprenorphine, who was deputy director of the Office of National Drug Control Policy in the first Bush administration.

Other experts warn that much remains to be learned about buprenorphine, but add that since doctors began prescribing the drug, the experience has been overwhelmingly positive.

For decades, federal law has prohibited use of any drug but methadone for heroin addiction. Congress loosened the law in 2000, and the Food and Drug Administration ruled that doctors could prescribe buprenorphine for addiction treatment in October. To prescribe it, a doctor must first take an eight-hour course and register with the US Drug Enforcement Administration. Federal law prohibits prescribing to more than 30 patients at a time. About 2,000 doctors nationally have been cleared to prescribe the drug, according to Dr. H. Wesley Clark, director of the federal substance abuse center.

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