Pubdate: Sat, 03 Jun 2006
Source: Boston Globe (MA)
Copyright: 2006 Globe Newspaper Company
Contact:  http://www.boston.com/globe/
Details: http://www.mapinc.org/media/52
Author: Scott Allen, Globe Staff
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

DOCTORS, ADDICTS TO RALLY FOR BETTER ACCESS TO TREATMENT DRUG

Say Federal Rules Hurt Those Who Could Be Helped

With heroin and OxyContin abuse at epidemic levels, Massachusetts 
doctors say they are increasingly frustrated by tight federal 
restrictions that force them to put addicts on a waiting list for the 
most promising treatment for opiate addiction in decades.

Suboxone is the first treatment for addiction to heroin and narcotic 
pain relievers that doctors can prescribe rather than sending 
patients to a methadone clinic, making it more attractive for younger 
addicts and addicts who hold jobs and other responsibilities. 
Suboxone can be taken at home, and , unlike methadone, it doesn't 
make patients groggy and there is little risk of a fatal overdose.

But Congress allows doctors to treat no more than 30 addicts at a 
time with the somewhat addictive drug, and only after they've 
completed an eight-hour course. In Massachusetts, 425 doctors are 
approved by the US Drug Enforcement Administration to prescribe 
Suboxone, barely enough physicians to prescribe the drug to all the 
heroin addicts in the Boston area alone. Doctors in other states have 
reported waiting lists for the drug of up to 300 addicts, while some 
Massachusetts doctors say they have stopped counting how many 
patients they turn away.

"This medication has the potential to wipe out at least 50 percent of 
the national demand for heroin," said Dr. Claude Curran , a Fall 
River psychiatrist who defied the federal limit last year. Curran 
prescribed Suboxone to 800 patients before the DEA forced him to 
dramatically scale back by transferring patients to other doctors or 
terminating their treatment.

Curran plans to lead a protest at the JFK Federal Building in Boston 
this afternoon , bringing together addicts, their families, and 
treatment providers to rally support for a measure just introduced in 
the US Senate to allow at least some doctors to treat far more than 
the current limit.

However, state officials caution that relaxing limits on 
prescriptions of Suboxone could cause problems. While Suboxone is 
less dangerous than methadone -- implicated in more than 1,100 deaths 
since 1970 -- it is also less effective for hardcore addicts. And, 
just three years after it went on the market, the US Justice 
Department reports a black market for the drug, which is potent 
enough to get non-opioid addicts high.

"We've got to be careful that this is done in a thoughtful manner," 
said Michael Botticelli , the assistant public health commissioner of 
the state Bureau of Substance Abuse Services. "It's important that 
this not become a pill factory [or] a cash cow for physicians who 
want to make money" from the opiate epidemic.

Up to a million people nationwide are addicted to heroin and 4.4 
million people abuse narcotic pain relievers such as OxyContin. Both 
drugs are chemically related to opium and can create a powerful 
craving for more. Only about 15 percent of addicts who go "cold 
turkey" are still drug-free a year after they get out of detox, 
according to Dr. Mark Eisenberg of Massachusetts General Hospital.

Since 1973, methadone has been the main long-term treatment for 
opiate addicts, giving them a daily high that temporarily eases their 
craving for opiates. But the rise of cheap heroin and abuse of pain 
relievers created new classes of addicts from experimenting 
20-somethings to middle-aged working people who got hooked after 
taking pain pills for an injury. These patients didn't want to go to 
a clinic for care and they feared methadone's side effects.

Suboxone, also known as buprenorphine , seemed to offer a real 
alternative when approved in 2002, and addicts raved that the new 
drug controlled their cravings without dulling their minds.

"I said, 'Wow. I want this forever,' " said Barry Andrade , who took 
the medicine in the early 1990s as part of a study. "I was 
functional. I was working. I was married. I was paying my bills."

When the study ended, he recalls, he went back to heroin and was 
jailed repeatedly for drug offenses until he began taking 
buprenorphine again recently. Andrade said he searched for years for 
a doctor who could prescribe it to him before finding Curran.

Though 9,200 doctors nationwide are now authorized to prescribe 
Suboxone, the limit of 30 addicts per doctor makes it virtually 
impossible to treat most of the people who need help, said Dr. Karen 
Kagey of Medway, who plans to attend the rally. "I turn down eight or 
10 people per month at least, sometimes more," she said. "Some of 
them say they have called 50 or 60 doctors."
- ---
MAP posted-by: Beth Wehrman