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On October 8, 2002, the Food and Drug Administration approved Buprenorphine to be used for detoxification and treatment of opiate addiction. We have used Buprenorphine for over a year, and it is a major advance in the treatment of heroin and prescription narcotic addictions. Buprenorphine increases the options for treatment and will be appropriate for new types of clients not currently involved in medical treatment for heroin addiction.

Appropriate types of patients may include people with physical dependence on heroin, whether they inject, snort, or smoke it, or those with addictions to prescription pain killers. Candidates also include people with relatively short addiction histories, such as young adults or adolescents who are at particularly high risk for serious complications of addiction, such as overdose deaths, suicide, HIV and other infectious diseases.

Methadone is a very effective and safe medication that has been the most commonly utilized treatment for opiate dependence. Daily methadone use has a high success rate in enabling people to live normal lives. Unfortunately, methadone has street value. An Ithacan who needs Methadone has to go on a waiting list and then drive daily or several times weekly to a methadone clinic in Binghamton or Syracuse to pick up carefully doled-out doses. There is an untapped population of chronic, active opioid addicted people who are not receiving any treatment and may opt for treatment with buprenorphine since it is more accessible to them.

There are people who are addicted to heroin and are able to recover through drug-free programs. However, there are many people with heroin and prescription drug addictions who fail traditional, non-drug treatments. I see these people when they have developed Hepatitis C or AIDS (from the ongoing heroin use) or have otherwise ruined their lives from the way they get drugs (theft, crime, jail sentences).Treatment resistant heroin use has disrupted the lives of many high school and college students. Buprenorphine can be used to enable a student to get into recovery and allow him or her to remain in school.

Buprenorphine alone is not sufficient but should be combined with counseling to help people develop the skills associated with recovery. Some people will choose to stay on Buprenorphine for a short time while they develop those skills and a recovery network.

Studies show that a progressive lowering of opiate dosage for 6 months improves long-term success. Buprenorphine, which can be now prescribed in Tompkins County can greatly aid in that process. Buprenorphine is a partial agonist, meaning that no matter how much you take you’ll only get 20 to 30 percent of the effect of a full dose of heroin or morphine. Buprenorphine thus has an impressive margin of safety. Like methadone, it can help correct abnormalities in brain glucose metabolism that occur in addicts.

Buprenorphine also binds irreversibly to opiate receptors for 2-3 days, so that if someone shoots up heroin during that time, nothing will happen. Like methadone, Buprenorphine in proper doses does not interfere with driving or thinking. Buprenorphine is much safer than heroin use. It is a promising option in terms of reducing heroin use and for retaining people in treatment.

John Bezirganian, M.D. is certified both in psychiatry and Addiction Medicine and is the medical director of the Alcohol and Drug Council of Tompkins County, Inc. Sober Talk appears in the Ithaca Journal on the first Thursday of each month. Contact us at 274-6288 or at www.alcoholdrugcouncil.org.