Buprenorphine – Fewer Side Effects than Methadone

In an unusual move, city Health Department officials are quietly encouraging physicians, hospitals, methadone clinics and prisons to prescribe the drug buprenorphine to heroin addicts, believing it will lure more addicts into treatment. Buprenorphine — a relatively new drug that goes by the nickname “bupe” and comes in a pill form — offers a new set of treatment options for opiate abusers, said Dr. Lloyd Sederer, executive deputy commissioner of the city Department of Health and Mental Hygiene.

Fewer side effects
Chemically, the drug partially blocks the same brain receptors that heroin and methadone target. But unlike those drugs, it doesn’t produce the same “high” or level of dependence. In addition, withdrawal from buprenorphine produces less severe symptoms and fewer drug cravings.

“The new medicine works differently in two ways,” Sederer said. “Bupe has a ceiling effect and reaches a certain point where it doesn’t get you higher, so it is much less likely to be abused or sold on the streets. With heroin and methadone, the more you take, the higher you get, and your lung function is depressed. The respiratory failure is what results in death.”

Methadone has been the standard for heroin addiction treatment since the early 1970s. But the syrupy, amber liquid is highly habit-forming and by law must be distributed — one dose at a time — at a special clinic. That stricture causes some who would seek treatment to shy away.

“People say that methadone leaves them punchy, and they have difficulty thinking and working,” Sederer said. “The long-term data on people in methadone programs shows that they are more stable, not involved in crime, and that’s a good thing, but only a small percentage are working [in jobs].”

Relatively new drug
Despite the potential benefits of buprenorphine, the drug remains virtually unknown and unused by the city’s heroin addicts. According to city health officials, only about 1,000 people use it, compared with an estimated 34,000 taking methadone.

Sederer and other city health officials want to see a significant change in those numbers. The goal is to have more than 100,000 opiate addicts using buprenorphine for detox maintenance by 2010.

“We are not reaching enough people with the treatments that we have,” Sederer said. “Not everybody should be on methadone.”

Like methadone, buprenorphine is heavily regulated, and may be prescribed only by certified doctors, of which there currently are 345 statewide. In addition, those prescribing the drug are bound by a 30-patient limit, a federal restriction guarding against prescription abuse that Sederer and other health officials hope will be changed so that more patients can be treated.

Some private doctors have been reluctant to prescribe the drug, fearing their offices would be inundated with addicts.

The drug’s pill form would be more attractive to white-collar users trying to avoid methadone clinics, experts said.

Somewhat complicating the picture, there are varying camps in the medical community about how to treat opiate addiction. Some, including Phoenix House, the country’s largest drug-free residential rehabilitation program, use bupe for detoxification; other programs use it solely as a maintenance drug to replace methadone.

Dr. Terry Horton, the medical director of Phoenix House in the city, calls buprenorphine “the most significant development in the treatment of opiate addiction in 40 years.”

“But,” Horton noted, “it is not a replacement for methadone but should be considered another tool we can use to treat opiate addiction.”

Could streamline treatment
The goal, drug treatment experts said, is for more doctors to be able to prescribe buprenorphine and for patients to be able to pick it up at the pharmacy.

Potentially, thousands of people could benefit from the drug. The city spends $50 million annually on treatment of an estimated 200,000 heroin addicts and 200,000 others addicted to prescription painkillers like Vicodin, Percocet and OxyContin. The state Office of Alcoholism and Substance Abuse Services will spend $313.7 million in 2005-06 to treat those battling against alcohol and other drug-related addictions, spokeswoman Jennifer Farrell said.


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