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Buprenorphine May Not Be 'The Latest' for Long: More Rx Options Could Help Build Office-Based Treatment of Opiate Addiction

Article excerpt

Charles R. Schuster, Ph.D., director of the substance abuse division at Wayne State University's medical school, runs a survey funded in response to congressional concern that buprenorphine, the newest medication available in the U.S. to treat opiate addiction, might be subject to diversion.

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More than two years after the medication's introduction, about 99 percent of the diversion Schuster finds involves people who buy buprenorphine on the street--not to get high, but to try it as medication for their addiction. Apparently, they have heard it works.

By all accounts, the landmark change heralded by buprenorphine's introduction continues to progress. And the structure it is taking is important not only in its own right, researchers indicate, but also for how it may contribute to some big leaps in medication-assisted treatment that are expected in the next decade.

Prominent addiction scientists called buprenorphine's introduction possibly the most important advance in anti-addiction medication since the advent of methadone about 40 years ago. In mid-2005 the experts are still excited about how well the new option is working.

"The physician reports that we receive indicate that they are extremely pleased with the success that they are having," says Schuster.

"I think there have been very few problems, a lot of successes, and right now we seem to be on the side of the angels," says Frank Vocci, Ph.D., director of the division of pharmacotherapies at the National Institute on Drug Abuse (NIDA).

Office-based metamorphosis

A big part of the buprenorphine shift is the change in the law Congress passed in anticipation of its release and in recognition of its low abuse potential. For the first time in about 80 years, patients can get prescriptions for anti-opiate medication in the privacy of a doctor's office and they don't have to return daily or at very short intervals, as is the case with clients at methadone clinics.

After two years of experience with office-based treatment, some of the outlines of the change engendered are emerging.

Already nearly 5,000 physicians have received the certification to prescribe the medication, and the number is climbing steadily. An estimated 150,000 to 200,000 people have been treated since the introduction, a faster acceptance rate than researchers expected. For comparison, something over 200,000 people are in the methadone system at any one time.

First inklings, at least, bode well for the larger hope for buprenorphine's role as a harbinger, even a foundation, of greater shifts that may come.

A slow history

Placed in a historic context, future changes could be very rapid. In the last 40 years, only four major drugs have come to the fore in opioid addiction treatment.

Methadone, introduced in the 1960s, is still the most widely accepted medication. And it's still a good system, Vocci says. "It really does turn around a lot of people."

But because of potential for abuse and diversion, regulations confine methadone dispensing to narcotic clinics, and those clinics are not available in all areas. In addition, many people are uncomfortable with the lack of anonymity in the clinics. The rules also usually require that patients return to the clinic daily at first to get the medication, then at longer intervals over time.

Naltrexone (ReVia), approved in the 1980s to treat opiate addiction and in the 1990s to treat alcohol dependence, has not been widely used because it leaves patients with craving. A longer-acting medication, LAAM (lexo-alpha-acetylmethadol), had been making some headway in recent years, but sales were discontinued in 2003 after reports of cardiac-related events.

Buprenorphine, with the brand names Subutex and Suboxone (the latter of which is buprenorphine plus naloxone, an agent that helps combat diversion), was approved in 2002. …