Good News!! Go to CBS Healthwatch. Then quick search for "heroin treatment" (Without quotes) This is a Jan 2000 article

                                         A New Treatment for Heroin
                                         Chris Dickey, Medical Writer

                                         Sometime early in 2000, treatment of people with
                                         heroin addiction in the United States will change
                                         radically, according to several experts in the field.
                                         Instead of being forced to go to a clinic nearly
                                         every day, patients with heroin addiction will simply
                                         visit their physician once a month to receive a
                                         prescription for a pill that dissolves under their

                                         "One of the hopes is that individuals addicted to heroin could receive
                                         treatment in mainstream medicine--in the office of their internist," says Dr.
                                         Herbert Kleber of Columbia University.Thus the person in the chair next to
                                         you in your doctor's waiting room may soon be one trying to shed their
                                         addiction to heroin.

                                         "It will essentially change the paradigm of opiate addiction," says Charles
                                         O'Keeffe, president of Reckitt & Colman Pharmaceuticals, Inc., the
                                         manufacturer of one of the new prescribed drugs for heroin addiction. "A lot
                                         of patients who are addicted to opiates are reluctant to enter treatment
                                         because they have not been able to go to a practicing physician in his or
                                         her office. This treatment will allow them to do that."

                                         Two new treatments for heroin addiction are
                                         winding their way through the approval process at
                                         the Food and Drug Administration. The first is called
                                         Subutex and is based on a narcotic called
                                         buprenorphine that acts at the same sites in the
                                         brain as heroin. When buprenorphine is in an
                                         addict's system, heroin has no effect for as many as
                                         2 or 3 days, allowing the body to reduce its powerful
                                         craving for the drug. The second is called Suboxone
                                         and is a combination of buprenorphine and a drug
                                         designed to counter the effects of both heroin and buprenorphine--naloxone.

                                         Who Will Benefit?

                                         There are about 800,000 heroin addicts in the United States, according to
                                         Dr. Herbert D. Kleber of Columbia University. Approximately 170,000 are
                                         treated in clinics that administer methadone.

                                         Some of those in treatment will want to be on buprenorphine, but they aren't
                                         the main population that will benefit from the drug's approval for
                                         administration in physician's offices. "It's going to be most useful for those
                                         who aren't in treatment," says Kleber.

                                         Kleber points to three populations in particular who may benefit from the
                                         new treatment:

                                         Citizens of states like Vermont where methadone is not available.

                                         Addicts who are turned off by going to the clinic for a variety of reasons
                                         including loss of anonymity. They may welcome the opportunity to go to the

                                         People who don't like methadone because they may have heard how
                                         difficult it is withdraw from. Buprenorphine may be an easier addiction to

                                         Dr. Frank Vocci of the National Institute on Drug Abuse agrees with Kleber
                                         that there is a potential treatment group of roughly 600,000 addicts in the
                                         United States. "It is reasonable to expect that 25% of that group might one
                                         day be treated either with buprenorphine or the combination of drugs,"
                                         Vocci says. He cautions, "It's not going to happen in the first year."

                                         A New Law

                                         For 25 years the treatment of people with heroin addiction has been
                                         governed by the Narcotic Addict Treatment Act, which sets strict regulations
                                         on the use of narcotics to treat addictions. So far only two narcotic
                                         treatments have been approved for this population--methadone and
                                         levomethadyl acetate (LAAM; brand name Orlaam). Because of the nature
                                         of the Act, these two treatments can only be administered in strictly
                                         structured settings.

                                                              "The wording is such that physicians and caregivers
                                                              can dispense narcotics to addicts but they may not
                                                              prescribe them," says Vocci. "There is legislation
                                                              winding its way through Congress now that is meant
                                                              to change that." The Drug Addiction Treatment Act
                                                              of 1999 recently passed in the US Senate, and is
                                                              now on the agenda for the House of
                                         Representatives when they return from winter recess. The new legislation
                                         will allow narcotics treatment for drug addicts to be delivered via a
                                         prescription drug, potentially changing the point of contact for the addict.

                                         Vocci stresses that the legislation does not influence the FDA approval
                                         process. But passage will allow buprenorphine to be prescribed by
                                         selected physicians--ones who treat more than a certain number of addicts
                                         and who apply to the FDA to be allowed to prescribe in this program.

                                         Why Naloxone?

                                         If the person addicted to heroin uses buprenorphine correctly, allowing it to
                                         dissolve under the tongue, then injected or otherwise ingested heroin will
                                         have no effect: It will be nearly completely blocked by the narcotic effect of
                                         the buprenorphine. Suboxone combines two drugs, one a narcotic and the
                                         other an antinarcotic, on the theory that addicts may try to use
                                         buprenorphine in the same way they are used to using heroin. If the pills are,
                                         for instance ground into a powder and injected, the addict will feel no effect
                                         from the buprenorphine. The effect is essentially blocked by the naloxone.
                                         "Naloxone is 100 times more potent when it is injected than when it is
                                         administered orally," says Kleber. "As long as you take it as directed, your
                                         body doesn't know it's there." An addict who injects buprenorphine might
                                         even go into withdrawal, according to Kleber.

                                         Because of its effect when injected, the addition of naloxone also reduces
                                         the value of the buprenorphine on the street, discouraging addicts from
                                         trying to sell their prescriptions.

                                         Opening the Door

                                         In a speech on the floor of the Senate on November 10, 1999, Senator Orrin
                                         Hatch addressed the need to change the law to allow physicians to
                                         prescribe buprenorphine. "This new system to treat heroin addicts can also
                                         act as a model that can be expanded in the future, as antiaddictive
                                         medications are developed," Hatch said, "to encompass the treatment of
                                         other forms of drug addiction."

                                         "My hope is that we will develop an arsenal of interventions," agrees Kleber,
                                         pointing to the treatment options available to physicians for depression as
                                         an example. "There are a dozen antidepressants out there," he says.

                                         Current Treatments for Heroin Addiction

                                          Methadone Programs

                                          For the past 30 years, the main treatment for heroin addiction has been

                                          When properly administered, methadone is not intoxicating.

                                          After taking methadone, people can even perform most ordinary
                                          activities--such as driving a car. Methadone reacts with the same
                                          receptors in the brain targeted by heroin, so it relieves much of the
                                          craving associated with heroin withdrawal.

                                          In addition, methadone blocks the effect of heroin, reducing the likelihood
                                          that the addict will continue using the drug while in treatment.

                                          Methadone's effects last for about 24 hours--four to six times as long as
                                          those of heroin--so it needs to be taken only once a day. Under FDA
                                          guidelines, according to Dr. Herbert D. Kleber at Columbia University's
                                          Division on Substance Abuse, people with heroin addiction are
                                          compelled to visit the methadone clinic six times a week for the first 3

                                          If they continue to test negative for the presence of heroin after 3 months,
                                          then they begin receiving weekend bottles (five visits per week with a
                                          bottle given out for Saturday and Sunday).

                                          At 6 months the addicts qualify to visit four times per week.

                                          Eventually, after 2 or 3 years, the addict will only visit the clinic once a
                                          LAAM and Other Medications

                                          Levomethadyl acetate (LAAM; brand name Orlaam), a longer-acting drug
                                          than methadone, can be used three times a week, reducing the expense
                                          and the problems of daily client visits. A dose of 80 milligrams three times
                                          a week is comparable to 30-100 milligrams of methadone daily.

                                          LAAM, like methadone, is a synthetic opiate that can block the effects of
                                          heroin for up to 72 hours with minimal side effects when taken orally. In
                                          1993 the FDA approved the use of LAAM for treating patients addicted to
                                          heroin. LAAM is usually available in clinics that already dispense

                                          Naltrexone is a type of drug known as an opiate antagonist. It blocks the
                                          effects of morphine, heroin, and other opiates. As an antagonist, it is
                                          especially useful as an antidote for heroin overdose. Naltrexone has
                                          long-lasting effects, ranging from 1 to 3 days, depending on the dose, and
                                          it blocks many of the pleasurable effects of heroin. Naltrexone has also
                                          been found to be successful in treating former prisoners who are
                                          recovering addicts.
                                          Behavioral Therapies

                                          "A drug is part of an overall treatment," says Kleber. "It must be given in
                                          an appropriate context."

                                          There are many effective behavioral treatments available for heroin
                                          addiction, including residential and outpatient approaches. Several new
                                          behavioral therapies, such as contingency management therapy and
                                          cognitive-behavioral interventions, also show particular promise as
                                          treatments for heroin addiction. Contingency management therapy is a
                                          system based on the use of vouchers: Negative drug tests earn points
                                          that can later be exchanged for items that encourage healthy living.
                                          Cognitive-behavioral interventions are designed to help modify the
                                          patient's thinking, expectancies, and behaviors and to increase skills in
                                          coping with everyday life.