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Buprenorphine as a treatment for heroin addiction

Buprenorphine is an opioid drug with many similarities to the other opioid drugs. Like other opioids, it is useful as a pain killer and for other medical purposes. If you are interested in a more complete discussion of the chemical makeup see http://en.wikipedia.org/wiki/Buprenorphine

For purposes of this discussion, and for purposes of treating drug addiction, the lay reader will probably best understand buprenorphine as a drug similar to methadone.

That is, it provides treatment by manner of "drug substitution". As discussed in What are the treatment options for someone with a heroin problem? nearly all modalities of drug treatment have about the same success rate (where success is described as abstinence) -- about five percent per year.

Buprenorphine and methadone treatments don't seek to keep the patient abstinent during treatment. They are intended to manage the cravings and other problems associated with addiction by a safely managed dose of another drug. That is, the patient is still "addicted" to a drug in the sense that they are taking it to ward off withdrawal symptoms, but it is easier to get their lives under control because they are no longer running the streets at night and/or committing crimes to get their fix.

As a treatment for addiction, buprenorphine has one major advantage over methadone. Doses of buprenorphine typically last two days, rather than one day for methadone. This may not seem to be much of an issue until you consider that patients are rarely allowed to leave the clinic with these drugs. That means that they have to visit the clinics every day, or at least every other day. Considering the fact that the clinics are not at all abundant and may not be located near where the patient lives, this can be a major hindrance to effective treatment.

One more problem with buprenorphine is purely legal.

The Drug Addiction Treatment Act of 2000 limits physicians to prescribing buprenorphine for opioid addiction to a maximum of 30 patients at one time.

That quote comes directly from the Substance Abuse and Mental Health Services Administration, a part of the US Department of Health and Human Services.

If you have someone with a drug problem in the family, and you know the extreme limitations there are on the availability of some of these programs -- and the crying need for them -- you might well wonder, as I did, why they have such a restriction. Personally, I think the answer is simple legislative ignorance -- the same explanation for most of our modern drug laws. But don't take my word for it. Write to your representatives in Congress and ask them.


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