July 20, 2007
BUPE, THERE IT IS
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Daniels credits buprenorphine for his new outlook on life |
Housing Works client Connie Daniels has been addicted to drugs for the majority of his 55 years. There were times he really wanted to quit. He tried methadone programs to treat his heroin habit, but grew restless spending his weekends in the clinic. "Methadone was like liquid handcuffs," he told the Update. "If my family wanted to go away for a weekend, we'd have to postpone the trip." Besides, he always ended up trading methadone for heroin again.
This February, however, Daniels' life changed. After he overheard his daughter say she was embarrassed to be seen with him when he was high, Daniels joined Derek Wyche's drug user's support group at Housing Works West 13th Street center. There, he found out about buprenorphine, a drug used for opioid maintenance that he had heard about "through the grapevine." The best part of the new treatment? Daniels could take it at home. He started on buprenorphine and has been clean ever since."This is the longest I've been off drugs in 25 years. I've been addicted to something for a real, real, real long time," said Daniels. "I'm like a walking advertisement for this treatment."
New York City's Department of Health and Mental Hygiene (DHMH) would like to see more people like Daniels on "bupe," as the drug is commonly called. Since 2003, it has trained and certified more than 800 New York City doctors to prescribe buprenorphine (before 2003, only 345 docs were certified). There are currently about 1,200 New Yorkers using bupe for opiate addiction, which is drastically short of the 100,000 DHMH would like to see benefiting by 2010.
To get closer to that goal, the DHMH is working to expand bupe availability at primary care settings and at community health centers, as well as trying to increase awareness of the treatment. "Ideally, any person who is dependent on opiates would know about the buprenorphine program and be able to ask for and access it," a DHMH spokesperson said.
Transitioning to bupeSuboxone and Subutex, brandname versions of buprenorphine, received approval by the FDA on October 8, 2002. At first, the treatment was highly regulated, with registered doctors only allowed to treat 30 patients at a time. But in January the Substance Abuse and Mental Health Services Agency relaxed regulations so doctors could treat up to 100 patients at a time.
Buprenorphine can only be used for a specific phase of drug treatment: Patients must already have started methadone and gotten down to a low dose or quit heroin cold turkey and be in withdrawal. (It is actually easier for patients to go from heroin withdrawal directly to Buprenorphine than from methadone to buprenorphine. Heroin is a short-acting opioid and easier to get out of one's system than methadone, which has an extremely long half-life.) Patients have been known to successfully transition to bupe after quitting a 20-bags-a-day heroin habit."Buprenorphine is a fantastic drug," said Edward Manchess, acting director of the Positive Health Project. "We're advocates of methadone as well, but this gives addicts another treatment option." Dr. Jonathan Weinstein, Housing Works' medical director, agreed. "Bupe is a great alternative for people trying to get off the last few milligrams of methadone."
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buprenorphine |
While not a miracle drug, perhaps bupe's greatest advantage is that it comes in a tiny pill that can be taken at home. Daniels, for example, started out seeing a Housing Works doctor weekly to regulate his intake but now only sees him once a month. Methadone, in contrast, can only be administered at a highly regulated clinic. "I had a patient who switched from methadone to buprenorphine. He told me that it freed up so much time, he now has time to look for a job," said David Rosenthal, director of the Lower East Side Harm Reduction Center (LESHRC). In the five months since LESHRC's doctor got certified, 15 patients have been prescribed the treatment. "It hasn't been a difficult sell," he said.
While methadone clinics are supposed to be a supportive environment, they often set off triggers that keep people using. Users in the program are there because of a court order and aren't serious about getting help. " A lot of times going to those programs is just going to a place to buy drugs," Wyche said.
Buprenorphine's practical benefit is also its potential liability. "If someone has an out-of-control substance abuse problem and they have an unstable living situation, that is someone who can't do well with buprenorphine," said William Mullen, clinical liaison for Reckitt Benckiser, a company that makes Suboxone. "Are they somewhat stable? Are they actively engaged in a homeless center? Are they engaged with their parents? These are the types of things we look for."
Although buprenorphine is a narcotic, another of its benefits is that it has to be taken under the tongue and can't be crushed or injected. This makes it almost impossible to overdose and gives the drug an extremely low street value.
"The biggest obstacle is fear"Wyche, a community follow-up worker for Housing Works, runs support groups for those trying to get off opioids at 13th Street and East New York. This month the groups are expanding to Crosby Street and 9th Street. Since Wyche began these programs in February, he has seen increased interest in bupe. Some clients are working hard to lower their methadone dosage so they're eligible to take it. While only about a dozen Housing Works clients are currently on the drug — most are on too high a dose of methadone — the number should increase as word of its success spreads. "The biggest obstacle is a fear of being in withdrawal," Wyche said.
Daniels said the only downside of buprenorphine is that, despite its low street value, some addicts will still try to buy it off of him. "There's a market, but I'm at a place where 'You can't buy mine,'" Daniels said, "I take it once every three days now, so I have extra. But I told my doctor, so now he orders less. I can't deal with all that hustling and crazy stuff anymore. I feel like I have my life back and I'm not going to give that up." Let's hope more folks like Daniels will be able to say the same soon.