New York Times (08.11.03) - Thursday, August 14, 2003
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
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
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.