Drug treats narcotic addictions, but it can cause one

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This from the Sun-Sentinel website:

Drug treats narcotic addictions, but it can cause one


Even Suboxone's advocates warn of increasing abuse

By Bob LaMendola
South Florida Sun-Sentinel
Posted May 28 2007



A pill that can help people kick addiction to narcotic pain drugs -- without going into rehabilitation -- has caught on fast in South Florida, where prescription drug abuse runs high.

The pill, Suboxone, now rivals methadone among people trying to quit opiates, including heroin, pain drugs oxycodone and hydrocodone, and even methadone, industry figures show.

But in South Florida, addiction specialists said they see growing signs that the cure is being abused, too.

Detoxification centers report rising numbers of clients addicted to Suboxone. Specialists worry that some doctors are hyping it as a miracle cure and prescribing it in careless or profit-oriented ways.

"It works great," said Dr. Sohail Punjwani, a detox specialist at Fort Lauderdale Hospital. "Suboxone is the new methadone. It's a little bit cleaner and a little more [effective]. But it can be abused. It's not a panacea. Some people are trying to say that it is."

Also, specialists said they are concerned that a few of the 127 doctors listed as certified by the federal government to prescribe Suboxone in Broward and Palm Beach counties have a history of improperly doling out pain pills.

Since they were certified, nine of them have had their medical licenses revoked, suspended or put on probation, according to state disciplinary records reviewed by the South Florida Sun-Sentinel.

"All the Suboxone doctors are not the best," said Robert Bozzone, chief executive of the nonprofit detoxification center Comprehensive Alcoholism Rehabilitation Programs in Palm Beach County.

The federal Substance Abuse and Mental Health Services Administration certifies doctors to give Suboxone if they have certain education or at least eight hours of training. The agency can deny approval based on a doctor's background, an agency spokeswoman said, but does not oversee their use of the drug.

"Unfortunately, some doctors approach it like a money-making business," said Dr. Douglas Smith, a Deerfield Beach pain specialist and Suboxone advocate.

Smith and at least 28 other doctors certified to give Suboxone work at pain clinics where opiate users may obtain the very narcotic pills they abuse. More than a dozen clinics advertise Suboxone in their pain-pill ads in weekly newspapers. That double role worries some detox specialists.

"You shouldn't be doing both. You could lose some of your objectivity" selling pills, said Dr. Dale Fahie, medical director at county-run Broward Addiction Recovery Center.

Suboxone and sister drug Subutex have been a hit since coming out in 2002. Studies show the pills work as well as methadone for kicking drugs without the agony of withdrawal, and with less risk of re-addiction and fewer side effects. The drug gives no high and people are less likely to abuse it.

Last year, Americans filled 1.2 million prescriptions for the drugs at a cost of $183 million, up from $12 million in 2003, the industry tracking firm IHS Health reported.

One-third of U.S. detox patients used them, another tracking firm, Decision Resources, reported.

Interest has been high in Florida, where 5 percent of people admitted abusing pain pills, including 12 percent of those ages 18 to 25, a federal survey in January indicated. Florida medical examiners report that deaths from opiates are on the rise.

Doctors at the Broward and Comprehensive treatment programs studied Suboxone for long periods before adopting it.

"It's much more effective," said Joanne Richter, assistant director at BARC. "You can't overdose on it."

The outpatient drug appeals to those with no time or health coverage for detox or who don't want to go to methadone centers alongside former heroin addicts, drug experts said.

"I feel like a normal person almost. I'm not having cravings. I'm not even thinking about it," said Adrienne, a Wellington mother using Suboxone to get off methadone, which she took for years to get off narcotic painkillers for migraines and injuries from a car crash. She spoke on the condition her full name not be used.

Adrienne, 33, started on Suboxone at Smith's pain clinic in Deerfield Beach in late April. She arrived during a brief, planned withdrawal -- needed for the drug to work correctly -- with jitters, a runny nose and an aching body. Four weeks later, down to one or two of the $8 pills a day, she feels good and is pretty confident she can stay that way.

Despite the positives, addiction specialists said Suboxone makes them worry. Among the concerns:

Patients abuse it. Officials at several centers said as many as 15 percent of their patients are withdrawing from Suboxone.

Some abusers take it to kill opiate craving while they get high on other drugs that don't react badly to it, such as Xanax, said Christopher Crosby, chief executive of The Watershed detox center in Boynton Beach. Others use Suboxone to get clean during the workweek, then abuse pain pills on the weekend. As a result, the drug now has a street value.

"It's like a whole new class of addicts now," Crosby said.

Pills without help. Some Suboxone doctors do not insist their patients get counseling or group therapy, which many studies show can be key to breaking addiction. They send patients home with pills and orders to check in every day or two, detox officials said.

"If these patients could just take a pill and go, `Whoa, I'm quitting,' they wouldn't be addicts," said Linda Burns, nursing director at Sunrise Detox Center in Lake Worth.

Smith and other advocates said forcing patients to go to counseling will drive the price of the treatment too high for patients without good coverage and deny it to those without support and time for therapy.

Long-term use. Suboxone doctors may allow patients to wean from the drug over months, or stay on it indefinitely. But some specialists frown upon long-term "maintenance," insisting their patients get off the drug in a week or 10 days. There's no definitive research on how long is best.

Such issues make officials fear that some addicts and doctors use Suboxone to cut corners in the battle to quit.

"Everyone is waiting for that magic pill," Burns said. "There isn't one."