Source:   Time Magazine
Author: John Cloud
Section: Health
Contact:    January 19, 1998 VOL. 151 NO. 2

A WAY OUT FOR JUNKIES?

In trials going on nationwide, buprenorphine seems to block the cravings of
heroin withdrawal

When Ted C., a heroin junkie and former baseball umpire, heard about an
experimental new treatment for his addiction, he was skeptical. Doctors
told him that a simple pill called buprenorphine could eradicate his
enormous craving for the narcotic, which he had been snorting daily for
several years. It sounded too good to be true--junkies live in fear of the
agony that arrives when a hit wears off--so Ted bought an extra bag of
heroin the night before he took buprenorphine for the first time. Just in
case.

But this time there was no pain. "I went to the clinic, took the pill and
went home. I used the last of the bag and haven't touched heroin since," he
says. That was April, and today he still takes the tablets--one a day keeps
the craving away--but he expects to stop using the drug in a few months.
"There was no struggle," he says. "There is no downside to the drug."

Testimonials such as Ted's have researchers across the U.S. claiming a
breakthrough in the treatment of heroin addiction. Today most addicts who
want to kick the drug are sent to clinics that administer methadone. But
that cure is nearly as troublesome as the disease it treats. 

Methadone produces its own high and is so addictive that it has its own
black market. To receive it legally, addicts must report every day to
authorized clinics, something many are loath to do. 

Before buprenorphine, Ted tried methadone and found the experience a lot
like taking heroin--only he had to get his fix in front of a mangy group of
drug pushers and criminals. The scene made him feel closer to drugs, not
free of them.

Buprenorphine is an opiate too, but it creates only a passing flicker of a
high, if that--and it is not addictive. Consequently, the FDA is expected
to approve the drug by spring, which would allow physicians to dispense it
from the privacy of their offices. For many, that will be not a moment too
soon. During the 1990s, heroin addiction has spread to groups ill-served by
existing treatment networks: professionals like Ted and middle-class, often
suburban, teens. The majority of addicts are still poor, city-dwelling
adults, but teens account for more than a fifth of those who say they have
taken heroin in the past year, double the proportion in the early '90s. 

Researchers believe more kids are using it because it is now sold in purer
form--pure enough to snort or smoke. Like Ted, most teens will not inject,
but they don't mind taking a puff or a sniff. (Injecting heroin is the
quickest way to experience its rush, but the drug still packs a punch when
snorted or smoked.)

For suburban kids, treatment options are sparse. Federally funded methadone
clinics are off limits to those younger than 21. Even at private clinics,
doctors are reluctant to prescribe methadone for all but the most hard-core
addicts. "Methadone itself is a terribly shackling drug, and putting young
or short-time users ... on methadone is criminal," says Paul Earley, an
addiction specialist at the Ridgeview Institute, outside Atlanta.

In the fight against addiction, breakthrough promises have been made and
broken many times; methadone was once considered a miracle drug, and heroin
itself was developed to cure addictions. But researchers say buprenorphine
could be the answer. Like heroin and methadone, it bonds to certain
receptors in the brain, blocking the pain they transmit and convincing the
brain that the cravings have been satisfied. Yet somehow it does that
without creating cravings for itself. Even long-term junkies who try
buprenorphine simply do not want heroin anymore.

So why has buprenorphine not replaced methadone? Although the drug has been
rumored since the 1970s to work well for addicts--and has been used in
France for more than a year--scientists only recently began the costly
clinical trials needed for government approval. 

Conducted at 12 hospitals around the U.S. and coordinated jointly by the
government and drugmaker Reckitt & Colman, the trials have gone extremely
well--so well that clinicians stopped giving placebos to control groups.
"We could not morally go on giving placebos to people who needed the drug,"
says Dr. John Rotrosen, one of the study's administrators.

The inevitable catch? No one is sure how long patients will have to take
buprenorphine before they can be free of it. Doctors say most heroin
addicts are addicted for life, even if they stop using it--a warning Ted C.
might well heed. What's more, buprenorphine will probably cost more than
methadone, ruling it out for poor junkies without government aid. Still, it
could be a lifeline for many of the estimated half-million American
addicts. Predicts Rotrosen: "It will fundamentally change the way heroin is
treated in the U.S."