Congress OKs prescription Buprenorphine

On July 2000 the U.S. House of Representatives overwhelmingly approved legislation that would - for the first time since the passage of the Harrison Narcotics Act of 1914 - allow general practitioners to maintain an opiate-dependent patient on a narcotic, in this case a Schedule IV or V anti-addiction drug. The legislation, H.R. 2634, was approved 412 - 1, with only Rep. Mark Sanford (R-SC) voting against the measure.

The sponsor of the bill, Rep. Tom Bliley (R-VA), is particularly interested in allowing physicians to prescribe buprenorphine, a Schedule V drug developed to treat heroin addiction by suppressing craving for the drug, but the legislation would allow doctors to prescribe any Schedule IV and V drugs approved by the FDA for use in drug maintenance or detoxification.

In order to prescribe such drugs doctors would have to be licensed under state law, demonstrate the training and experience to treat drug addicts, and exhibit the capacity to refer patients to counseling and other ancillary services. In addition they could not treat more than 20 people in an office setting at once unless the Secretary of Health and Human Services changed the guidelines.

Senator Orrin Hatch (R-UT) introduced a similar bill, S. 324, in the Senate last year. The language of that bill was incorporated in S. 486, the Methamphetamine Anti-Proliferation Act of 1999, which passed the Senate earlier this year. Since the buprenorphine provisions passed the Senate as part of S. 486, the Senate will not consider stand-alone buprenorphine legislation, such as S. 324.

The House Judiciary Committee, however, recently approved the House version of the Methamphetamine Anti-Proliferation Act, H.R. 2987, and that bill also contains the buprenorphine legislation. The full House is expected to approve H.R. 2987 sometime in September, after which time House and Senate members will then reconcile differences between each bill and produce a final bill acceptable to both Houses. The final bill is expected to still contain provisions allowing doctors to prescribe Schedule IV and V anti-addiction drugs like buprenorphine.

However, buprenorphine has not yet been approved by the FDA for addiction treatment, and doctors will not be able to prescribe the drug until it is approved. The FDA is currently considering approval for Suboxone, a combination pill made up of buprenorphine and naloxone. While buprenorphine reduces the craving for opiates and blocks withdrawal pains, naloxone sends users into severe pain if they take heroin or other opiates while on Suboxone or if they crush the pill into a powder, add a liquid and inject it in an attempt to get high.

Proponents of mixing buprenorphine with naxolone say that it is necessary to ensure that users don't misuse buprenorphine or take illegal drugs while they're receiving their treatment. Critics on the other hand charge that after the first time a patient falls back into the habit of taking heroin and suffers the terrible pain from naxolone, the user will be put in the position of continuing drug treatment with the imposition of severe pain anytime they make a mistake or staying out of drug treatment all together. Many addicts may choose to stay off Suboxone all together. Opponents of adding naxolone also point out that in countries where buprenorphine has proven to be successful in treating addicts it has not been combined with naxolone.

Even without naxolone however, buprenorphine has its limits as an addiction-fighting drug. While buprenorphine has proven successful in helping casual users or mild addicts in forgoing their habits, it has not yet proven successful in treating many heavily-dependent addicts. In the rush to make buprenorphine easily available, many fear that methadone, a more effective drug for treating heroin addiction (but one that is, with very few exceptions, available only in special clinics), will end up becoming even less available to those that need it. Many harm-reduction advocates worry that Congress, by approving prescription buprenorphine, will feel that they have done all that is necessary to fight heroin addiction, and that the expansion of methadone treatment and the easing of access to the drug will not move forward. Others feel that prescription buprenorphine is a first step to getting Congress to approve legislation that would allow doctors to prescribe any anti-addiction drug to their patients, including methadone.