More Reaction to Sun's Light on Buprenorphine
- posted by Jim Leitzel @ 9:51 AM

A few days ago Vice Squad mentioned the Baltimore Sun's investigative reporting on buprenorphine, an opioid commonly used to treat heroin addiction (which is rife in Baltimore). One part of the series concerns France, where buprenorphine is widely prescribed to addicts. This part of the series, like other parts, has attracted critical commentary from the treatment community. Today's letter (scroll down a bit) from two French addiction workers expresses dismay about both the story and the Sun's Public Editor's tepid endorsement. Their letter points out some information that did not appear in the Sun story:

Opioid substitution treatment now covers about 70 percent of drug users in France, and most receive buprenorphine. This change in policy has achieved:

• An 80 percent reduction in heroin overdose deaths (from 500 to 100 per
year).

• A 75 percent reduction in HIV prevalence among drug users (from 40
percent in 1995 to 11 percent in 2004).

• A 75 percent reduction in drug-related crimes.

Causality is always tricky, but it does seem that buprenorphine has been a very successful treatment for heroin addicts in France. Incidentally, much of the Sun's concern about buprenorphine "abuse" draws upon heroin addicts who purchase street bupe to stave off withdrawal when they cannot afford or access heroin. This use may not be undertaken under a physician's care, but it is far from clear that it constitutes "abuse" in the usual sense. (Though in the drug policy world, the abuse of "abuse" is common.)

Labels: addiction, buprenorphine, France

 
Sun Sets on Bupe
- posted by Jim Leitzel @ 9:53 AM

Just a quick note from Baltimore, where the Baltimore Sun recently has featured an investigative series of articles (first installment here) on the opioid agonist buprenorphine, a drug frequently used to treat heroin addicts. Sometimes buprenorphine itself is abused, and it is this possibility that garners the bulk of the Sun's attention. The Sun's Public Editor explains the coverage, and some of the fallout, here, without offering much of an assessment beyond a sort of tepid endorsement. A letter from a medical professional (with experience in the area) that appeared in today's issue of the Sun is illuminating:

It is telling that despite months of reporting and thousands of words, The Sun
did not find a single person in Baltimore whose life has been ruined by
buprenorphine.

Yet just walk the streets in East or West Baltimore and you
can find scores of people whose lives are being ravaged by the condition that
buprenorphine treats effectively.

Labels: buprenorphine, treatment

 
Bupe in B-more
- posted by Jim Leitzel @ 12:10 AM

In 2002, new FDA rules made it possible for doctors to meet in their offices with addicts, and to prescribe the opiate agonist buprenorphine. In the form prescribed, the buprenorphine is combined with the antagonist naloxone, thereby rendering the compound ineffective in taking by injection for a high. Unlike methadone clinics, which generally require daily visits by patients, addicts treated with the bupe/naloxone mix could receive a month's supply at a time.

Vice Squad hometown of Baltimore, Maryland, is racked by a terrible heroin problem. In October, 2006 Baltimore announced that it was going to promote buprenorphine treatment for heroin addicts; the state of Maryland has earmarked $3 million for bupe treatment in the coming fiscal year. Unfortunately, Maryland doctors do not seem all that eager to climb aboard the bupe train, and those that do board find the journey to be arduous, according to an article this week in the Baltimore Sun:

"One of the biggest barriers to prescribing buprenorphine is dealing with the insurance companies," said Dr. Christopher Welsh, a psychiatrist and assistant professor at the University of Maryland School of Medicine in Baltimore. Welsh uses the drug to treat patients at the university's hospital. Some come from hundreds of miles away to get a prescription, only to have their treatment thwarted by red tape.

"A few hours later, you'll get a call, and the patient will tell you that the pharmacy said the prescription wasn't authorized," said Welsh, who participated in the survey.

He added that a physician who intervenes to help the patient is often "passed from voice mail to voice mail" by the health care provider, and the experience "can be very time- and labor-intensive."

Two years ago, Vice Squad noted a prescient Wired article detailing barriers to the spread of bupe treatment for heroin addicts.

Labels: addiction, buprenorphine, heroin, treatment

 
Parkinson's Disease and Internet Gambling
- posted by Jim Leitzel @ 10:14 AM

It has been known for some time that some drugs (dopamine agonists) used to treat Parkinson's disease raise the risk that the patient will become a pathological gambler. (Still sort of amazing, though, isn't it?) This week's British Medical Journal includes an editorial warning of the danger that easy access to internet gambling poses to Parkinson's patients. (The 6-page pdf including the editorial, along with four others, is here.) The editorial contains some statistics on problem gaming: about 1 percent of the adult population can be considered to be pathological gamblers, but 3.4 percent of Parkinson's sufferers fit the bill, while 7.2 percent of Parkinson's patients taking dopamine agonists are pathological gamblers. The editorial is timely in that proposed British regulations for internet gambling will soon be released.

The British Medical Journal frequently features articles relevant to vice policy researchers. A second editorial in this week's issue concerns the over-regulation of opiates prescribed for pain, while a news item notes that in former Soviet Georgia, excessive recreational use of buprenorphine -- an opioid that has shown much success in treating heroin addicts -- has become the nation's leading drug problem.

Labels: Britain, buprenorphine, gambling, internet, treatment

 
British Heroin Maintenance
- posted by Jim Leitzel @ 3:10 PM

Until the early 1970s, doctors in Britain could prescribe heroin to addicts. With increased addiction being tied to leakages from the prescription system, distribution of heroin for addiction maintenance was tightened. Today there are about 450 British addicts who receive heroin from some 100 specially-licensed physicians. But now, following the perceived successes of previous heroin maintenance experiments in Switzerland and the Netherlands, the British intend to initiate pilot programs that will expand prescription access by addicts to heroin.

Thanks to John Band at Shot By Both Sides for the pointer.

An alternative treatment for opioid addicts is the oral administration of buprenorphine. We noted a while ago some of the barriers to the spread of this treatment in the US; a detailed explanation of how buprenorphine treatment works, based partly on personal experience, is provided by Nephalim's Drug War Revealed.

Labels: Britain, buprenorphine, heroin, treatment

 
The Uphill Trek Facing Buprenorphine
- posted by Jim Leitzel @ 4:58 PM

Yesterday we looked at the use of naltrexone in the treatment of alcohol addiction; today's link is to a Wired story on the use of buprenorphine to combat opiate addiction. The article details the many barriers to making buprenorphine available to addicts, including the reluctance of doctors to welcome addicts into their waiting rooms and difficulties in first allowing and then easing the dispensing of buprenorphine from methadone clinics.

Relative to methadone, buprenorphine offers advantages to some patients, including the fact that a stock of bupe (its nickname) can be kept by the addict, with a pill taken daily to reduce opiate craving and withdrawal. Patient-managed inventories are possible because one form of bupe comes mixed with the opioid antagonist naloxone, thereby making it unattractive as a recreational drug. (The Wired article might even be a little too laudatory of bupe; opioids tend to have widely varying effects upon different users, so no doubt methadone or heroin maintenance would be preferable to bupe for some patients.)

Thanks to Ken Lammers at Crim Law for the pointer.

Labels: addiction, buprenorphine, heroin, treatment

 
Buprenorphine Treatment for Opioid Addicts
- posted by Jim Leitzel @ 6:28 PM

Methadone treatment for heroin addicts is pretty effective, as these things go. For many addicts, once-a-day methadone stabilizes them, prevents withdrawal, and allows them to maintain a more-or-less normal life. But it looks as if a drug called "buprenorphine" is even better, at least for many opioid addicts. You take it less frequently, and in the form in which it is provided in treatment, it is not easily subject to abuse. As a result, doctors can prescribe a month's supply at a time to an addict, reducing the need for clinic visits. It has only been available for treatment in the US for a short time. This fine story, in yesterday's New York Times, has more.

Labels: addiction, buprenorphine, heroin, treatment