viscousmemories
04-22-2005, 03:19 AM
The Bitter Pill (http://www.wired.com/wired/archive/13.04/bupe.html)
I read the above article in Wired today. It's about a drug called buprenorphine ('bupe' for short, but marketed as Suboxone) which one day might replace methadone as a method for overcoming heroin addiction.
Bupe won approval as an addiction treatment in late 2002. Sold by British firm Reckitt Benckiser and prescribed under the brand name Suboxone, bupe is a synthetic opiate that pushes the same buttons as heroin or painkillers like Vicodin, Percocet, or OxyContin, only without the high or any other significant side effects. It frees recovering addicts from cravings and crashes, allowing them to focus on counseling, work, and relationships. "It is the first real innovation in treatment in 40 years," says Phoenix House medical director Terry Horton.
<snip>
Patients on bupe do become physically dependent on the pill - as do people taking medication for most chronic conditions. Suboxone, though, has no strong side effects. Nor can users get high by taking a larger dose - in other words, no inching up from dependence to addiction. Bupe is also safer than methadone - which, like any strong opiate, suppresses breathing if too high a dose is taken - and easier to taper off. And instead of visiting a treatment center every morning or quitting cold turkey, addicts can get a bupe prescription from their regular doctor. This offers real appeal to addicts, particularly white-collar ones, who cringe at the stigma of methadone lines. "You're just taking medication," Solinda says. "You don't feel sick. You don't feel high. It makes you feel stronger as a person."
Unfortunately they've had considerable difficulty marketing and distributing the drug for various reasons.
So why has bupe's progress been so sluggish when it's clearly a superior innovation? There are several reasons. The general practitioners who were meant to write most of the prescriptions have proved ambivalent, at best, about treating addicts. Lawmakers have bungled regulations; at one point, there was even a federal law barring methadone clinics from dispensing bupe, despite their experience and reach within addiction circles. Meanwhile, Reckitt Benckiser has been conservative in marketing the new drug.
<snip>
It's all enough to drive Sederer crazy. Reducing the number of active addicts in the city would help check the spread of HIV and other diseases that hang out on dirty needles. It would lessen the number of deaths by overdose. It would cut crime; 20 percent of all convicted felons in New York test positive for opiates. It might even save money. The National Institute on Drug Abuse estimates that every $1 spent on drug treatment erases $7 in social costs ranging from unpaid ER bills to prison overhead.
<snip>
The regulatory problems didn't stop there. Influenced by tales of unscrupulous methadone clinics taking on huge case-loads for the reimbursement cash, Congress barred doctors from maintaining more than 30 bupe patients at a time. And in a monumental blunder, the law classified giant HMOs like Kaiser Permanente, as well as hospitals, as single providers, with the same 30-patient cap that Kolodny has in the solo practice he maintains on evenings and weekends. Four years later, the law remains unchanged. One clear sign of the law's unintended consequences: The world-renowned Addiction Institute of New York (better recognized by its old name, Smithers) doesn't mention bupe in its advertising because with a 30-patient limit, it fears it would have to turn people away.
So why the goofy thread title? The most amusing part of the article:
"Any questions?" he asks. One employee is still confused about why Reckitt Benckiser needs help marketing its drug. If anything, pharmaceutical firms promote their products too well, turning millions of otherwise sensible Americans into Googling hypochondriacs, and doctors into vending machines.
"They are not a pharmaceutical company," Kolodny replies. "They make Lysol."
"Woolite, also," adds another employee. "And French's mustard," Kolodny says, smiling a bit. The room breaks up laughing.
I read the above article in Wired today. It's about a drug called buprenorphine ('bupe' for short, but marketed as Suboxone) which one day might replace methadone as a method for overcoming heroin addiction.
Bupe won approval as an addiction treatment in late 2002. Sold by British firm Reckitt Benckiser and prescribed under the brand name Suboxone, bupe is a synthetic opiate that pushes the same buttons as heroin or painkillers like Vicodin, Percocet, or OxyContin, only without the high or any other significant side effects. It frees recovering addicts from cravings and crashes, allowing them to focus on counseling, work, and relationships. "It is the first real innovation in treatment in 40 years," says Phoenix House medical director Terry Horton.
<snip>
Patients on bupe do become physically dependent on the pill - as do people taking medication for most chronic conditions. Suboxone, though, has no strong side effects. Nor can users get high by taking a larger dose - in other words, no inching up from dependence to addiction. Bupe is also safer than methadone - which, like any strong opiate, suppresses breathing if too high a dose is taken - and easier to taper off. And instead of visiting a treatment center every morning or quitting cold turkey, addicts can get a bupe prescription from their regular doctor. This offers real appeal to addicts, particularly white-collar ones, who cringe at the stigma of methadone lines. "You're just taking medication," Solinda says. "You don't feel sick. You don't feel high. It makes you feel stronger as a person."
Unfortunately they've had considerable difficulty marketing and distributing the drug for various reasons.
So why has bupe's progress been so sluggish when it's clearly a superior innovation? There are several reasons. The general practitioners who were meant to write most of the prescriptions have proved ambivalent, at best, about treating addicts. Lawmakers have bungled regulations; at one point, there was even a federal law barring methadone clinics from dispensing bupe, despite their experience and reach within addiction circles. Meanwhile, Reckitt Benckiser has been conservative in marketing the new drug.
<snip>
It's all enough to drive Sederer crazy. Reducing the number of active addicts in the city would help check the spread of HIV and other diseases that hang out on dirty needles. It would lessen the number of deaths by overdose. It would cut crime; 20 percent of all convicted felons in New York test positive for opiates. It might even save money. The National Institute on Drug Abuse estimates that every $1 spent on drug treatment erases $7 in social costs ranging from unpaid ER bills to prison overhead.
<snip>
The regulatory problems didn't stop there. Influenced by tales of unscrupulous methadone clinics taking on huge case-loads for the reimbursement cash, Congress barred doctors from maintaining more than 30 bupe patients at a time. And in a monumental blunder, the law classified giant HMOs like Kaiser Permanente, as well as hospitals, as single providers, with the same 30-patient cap that Kolodny has in the solo practice he maintains on evenings and weekends. Four years later, the law remains unchanged. One clear sign of the law's unintended consequences: The world-renowned Addiction Institute of New York (better recognized by its old name, Smithers) doesn't mention bupe in its advertising because with a 30-patient limit, it fears it would have to turn people away.
So why the goofy thread title? The most amusing part of the article:
"Any questions?" he asks. One employee is still confused about why Reckitt Benckiser needs help marketing its drug. If anything, pharmaceutical firms promote their products too well, turning millions of otherwise sensible Americans into Googling hypochondriacs, and doctors into vending machines.
"They are not a pharmaceutical company," Kolodny replies. "They make Lysol."
"Woolite, also," adds another employee. "And French's mustard," Kolodny says, smiling a bit. The room breaks up laughing.