Buprenorphine offers hope and help to heroin addicts

Buprenorphine has been prescribed as a replacement for methadone, in an attempt to reach heroin addicts who are unwilling to go on a methadone regime. Unfortunately, physicians have been reluctant to prescribe Bupe, fearing associating their practice with the treatment of heroin addicts, and regulators have made it difficult for Bupe to be administered by drug treatment facilities.

• Perfect conditions, his doctor said; bupe works only when patients are in withdrawal.
• The details of his addiction - kicked out of high school, stripped of a college basketball scholarship, and ultimately sent upstate to prison - already seem like stories from someone else's life.
• "It is the first real innovation in treatment in 40 years," says Phoenix House medical director Terry Horton.
• Before bupe, there was mainly methadone, an amber syrup that offers similar relief from opiate cravings but is highly habit-forming.
• By law, methadone must be dispensed at special clinics and, for most patients, only in single daily doses.
• While Reckitt Benckiser won't disclose sales data, Shaun Thaxter, vice president of pharmaceutical marketing, says that 5,000 doctors are now prescribing buprenorphine.
• Kolodny steers a big government sedan through the busy streets of Queens, past a billboard that promises, somewhat disturbingly, The World's Boldest Corrections Officers, then over the bridge to Rikers Island, where he'll talk about bupe to a group of prison docs and nurses.
• What they're doing is maintaining inmates on methadone, trying to tame their addictions before they return to the street.
• Kolodny hopes that with the enticement of meds donated by Reckitt Benckiser - seed drugs - the prison will agree to put some inmates on bupe instead.
• Then, when they check out, they can tell their neighbors about it and increase the pressure on local doctors to write prescriptions.
• They ask about the potential for black-market dealing; inmates learn to hold their methadone in their throat, spit it back up, and sell the spit.
• That's because of the nearly 300 doctors in New York licensed to prescribe bupe, only a handful will accept Medicaid, even though it covers the treatment.