The word's out on the street. People addicted to heroin or prescription painkillers are passing the word. There's a new treatment where you don't have to go through such a miserable withdrawal. It sounds too good to be true. Some are calling it a "miracle drug."

   It may seem like a myth on the street, but it's not. Treatment
professionals know its value. Approved by the FDA for use in this country
only a few months ago, it looks like it's just that good. It's called
Buprenorphine.
   So far, doctors are impressed. "The vast majority of patients - especially
if they've been through withdrawal before - expect four days of hell,"
says Dr. Rick Caesar, Serenity Lane's medical co-director. Over the last
two months, he has treated close to 30 patients using the new drug. After
going through withdrawal with it, he says, most "can't believe the
experience - how much less painful the withdrawal is."  (Photo: the horribly misnamed "flower of joy," the opium poppy.  It is a link to its source, a PBS page on the subject.)

   Caesar explains that Buprenorphine is actually in the family of opiates.
It is, however, unusual among them in that it removes virtually all
withdrawal symptoms with little or no euphoric or sedating effect. It
produces little of the drowsiness of Methadone. He adds that it's next to
impossible to overdose on the drug - also very different from Methadone,
which, while clearly life-saving, has to be carefully monitored.
   According to Caesar, Buprenorphine works because of its strong affinity
for the same nerve receptors in the brain affected by other opiates - "it
blows them off the sites." Not only are the symptoms of withdrawal
eliminated - the new compound actually blocks other opiates like heroin,
OxyContin, Vicodin or Percodan from taking effect at all.

   Like Methadone, patients intentionally become dependent on Buprenorphine.  If appropriate, maintenance therapy can be continued indefinitely, but Caesar says most patients gradually taper off. And while those taking Buprenorphine have to be careful about drug interactions, there appears to be no group of patients that can't use it safely.
   Today, the number of treatment facilities using Buprenorphine is small
(only three or so in Oregon) but growing. The federal government recently
approved licensing individual physicians to prescribe the drug to a
limited number of patients. For the first time, outpatient withdrawal will
soon be a possibility - particularly helpful in remote or rural areas.

   Are there any downsides to this "miracle drug"? It's hard to see any.
Still, one concern comes to mind. We know that fear of painful withdrawal
is one reason addicts don't quit, so Buprenorphine will encourage many
addicts to try and do so. But will the prospect of a more comfortable,
humane withdrawal actually encourage relapse - based on the thought that
"I can get high now because it's easier to stop later"?
   Maybe. It will be important to learn more by tracking patients over time.
But whatever we find, quality treatment programs will still be built on a
comprehensive approach using tools essential to successful recovery -
including 12-step programs, psychotherapy, and long-term recovery support.

   As more patients benefit from Buprenorphine, we all gain experience with
this promising new treatment. Meanwhile, as Caesar puts it, "we want to
alleviate as much suffering as we can." Buprenorphine certainly does that.
It offers real hope to many who otherwise would not get clean - some dying
as a result.

As the statewide coordinator of employer services for Serenity Lane, Jerry
Gjesvold helps companies throughout the state manage their drug-free
workplace programs. More information is available on the Serenity Lane
website at www.serenitylane.org. The opinions expressed in this column are
those of the writer.

© 2003 Jerry Gjesvold