Buprenorphine Expands Access to Addiction Treatment

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"It is its own worst enemy," Reuter said, because in some cases it works so well that patients think they're "cured" and decide to stop taking it.

Addiction specialists say it's typically a long-term treatment, although the length varies from patient to patient, sometimes depending on how long they've been addicted. Alfieri said that some patients do complain about not being able to come off even a very low dose.

The company is also investigating an implantable version of the drug.

And the drug is not without risks. Even in France where the drug is credited with reducing both drug overdoses and injection drug use, when buprenorphine was introduced there was a simultaneous uptick in opioid-related deaths due to an unforeseen consequence of combining crushed, injected buprenorphine with benzodiazepines like diazepam (Valium) or excessive alcohol intake.

Since diversion was an anticipated concern, addiction specialists in the U.S. have favored Suboxone, a version of buprenorphine that contains naloxone (Narcan), an opioid antagonist, in a 4:1 ratio.

"If you crush it, the naloxone kicks in and sends you into horrible withdrawal, so you don't want to do it again," Levounis said.

Reuter said there was an increase in buprenorphine diversion in 2006 that has since leveled off. And the diversion rate with buprenorphine remains low compared with that of opioid analgesics.

Suboxone has also been diverted in a less expected way. Prescription painkiller addicts will sometimes attempt to acquire it themselves, in order to kick their habit.

The treatment, however, requires that the patient be in withdrawal before starting it.

Stone recalls the withdrawal she had to force upon herself before starting Suboxone. "That was a night I never want to remember again," she says. Her physician gave her his cellphone and talked her through making herself more comfortable, which eased the process.

"I felt much better after the first 24 hours on the drug," she said, "and then even better the next day."

She says she hasn't used prescription painkillers since, although she is still on Suboxone and plans to be for a while. She now has a career in nursing again, as a case manager for a firm in West Virginia.

And she wants others who are struggling in her community to know that they have hope too.

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