Under My Tongue

 

In 2000, President Clinton signed the Drug Addiction Treatment Act, which reverses earlier decisions and permits physicians (who meet certain qualifications) to prescribe FDA-approved Schedule III, IV and V narcotic medications for the treatment of opiate addiction. This means that specially trained doctors (mainly psychiatrists) in the United States will now be able to treat patients in the privacy of their offices rather than making them suffer through the methadone circus, clearing the way for doctors to begin prescribing buprenorphine. Currently, in California, there are 175 doctors who have taken the required training. (To find them, go to http://buprenorphine.samhsa.gov/ and click on the “physician locator” tab.)

Also significant to the FDA approval process was the development of a non-injectable, and therefore less risky, version of buprenorphine, the result of a 10-year joint effort between Reckitt Benckiser, an English household-products company with a side business in pharmaceuticals, and the NIDA. Together they developed two different buprenorphine sublinguals (they’re dissolved under the tongue), Subutex and Suboxone.

The main difference between the two versions is that Subutex is pure buprenorphine, while Suboxone combines the opiate with Naloxone, which is a pure opiate antagonist (it’s what smack addicts get injected with when they end up in the emergency room). “If someone tries to crush the Suboxone and shoot it up,” says Dr. Anne Linton, who runs the Betty Ford Center and assisted with the early buprenorphine research, “they’re going to immediately find themselves sober and going into withdrawal.”

In these new formulas, buprenorphine is now much less of a liability; some health professionals predict it will make methadone obsolete. To others, however, there is still reason to worry. “I’m always concerned about supposed miracle cures,” says Joycelyn Woods, president of the National Alliance of Methadone Advocates. “You want to know why it took so long to get buprenorphine on the market here? It was introduced as a heroin cure in India, France and Scotland. These are countries where they don’t have methadone programs, but now they have buprenorphine addicts. The DEA knew about that and was trying to find a safer version. This is what they’ve come up with. We’ll see if it works.”