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BY MATTHEW DOUGHERTY
PRESCRIPTION PAIN MEDICATIONS HELP PEOPLE EVERY DAY FOR such common ailments as lower back pain. But for a small percentage of patients, painkillers can develop into a nightmare of drug dependence. As many as 13 million people in America abuse opiates, which include painkillers such as Oxycontin and illegal street drugs such as heroin.
Now Columbia is helping patients and physicians with drug-dependent patients learn about and administer a new treatment, buprenorphine. P&S started the buprenorphine program in October 2003 after the Food and Drug Administration approved the medication for prescription treatment of opiate abuse for patients. Until now, the only other medication option was methadone.
Buprenorphine is a partial agonist that blocks the effects of other opiates and eliminates the major motivation for opiate abuse by preventing withdrawal symptoms. It also produces less stimulation and physical dependence than other opiates such as methadone that are full agonists. It is also difficult to overdose on buprenorphine.
"These qualities make buprenorphine acceptable for office-based therapy as opposed to methadone, which can be abused more easily," says David M. McDowell, M.D., assistant clinical professor of psychiatry and director of the Columbia program. Therefore, methadone is only distributed in single doses at methadone clinics, which can be a burden for patients who need to come in before work to get a daily dose, for example. Once a physician initiates a patient on buprenorphine and is satisfied with the progress, the physician can allow the patient to take the drug at home much like any other prescription medication.
Doctors must complete an eight-hour training session — provided by the American Psychiatric Association, the American Society of Addiction Medicine, and the American Academy of Family Practice — and register with the Secretary of Health and Human Services to be certified to prescribe buprenorphine. Each approved doctor can prescribe the medication to a maximum of 30 patients, a measure to prevent physicians from prescribing the drug to too many patients, says Dr. McDowell.
So far, the program has started more than 150 patients on the medication. Preliminary results from research that has followed program participants for more than six months show a 14 percent relapse rate, which Dr. McDowell characterizes as an "incredible" finding. Besides Dr. McDowell, the staff consists of Herbert D. Kleber, M.D., professor of psychiatry and director of the New York State Psychiatric Institute's Division on Substance Abuse; Erik W. Gunderson, M.D., assistant clinical professor of psychiatry and medical director of the buprenorphine program; Roberta P. Sales, director of nursing and communications; and Margaret M. Rombone, Ph.D., a clinical psychologist.
Aside from treating patients, the staff has worked diligently to tell physicians and, by extension, patients in the New York area about the Columbia program and the treatment. Dr. McDowell, who is vice chairman of the American Psychiatric Association, has made presentations to substance abuse programs in the community and participated in the association's April forum on buprenorphine that 100 metropolitan-area physicians attended.
The Columbia program staff arranges for doctors and residents to observe how simple it is to start people on the medication and to conduct follow-up visits with patients. Third-year residents in psychiatry visit the program and one fourth-year resident will do a rotation in the program next year.
Dr. McDowell would like the program to participate more in both the psychiatric and medicine residency training programs. Dr. McDowell says that spreading the news about the benefits of buprenorphine has been a frustratingly slow process. "The two things that patients on the medicine say the most are 'Thank you, I feel like I got my life back,' and, 'How come I didn't know about this before?'" Dr. McDowell is committed to eliminating the last question. "We're working to get the word out."
For more information, contact the Columbia Buprenorphine Program at 212-342-1496 or 212-342-1512 or by email: info@BupProgram.com.
This article first appeared in the P&S Journal, Volume 24, No. 3, 2004.
It appears here by permission.
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