Curious Cure

Nicolas Martin has a sharp piece on the American Iatrogenic Association's site questioning the recent enthusiasm for buprenorphine, a narcotic painkiller, as a "treatment" for heroin addiction. He quotes an August 11 New York Times story extolling buprenorphine's advantages over methadone:

For many addicts, though not all, buprenorphine does what methadone does, blocking the addict's craving for a high, but experts and addicts say it has several advantages over the older drug, and the most important may be that a patient can get a supply, not merely a dose, with a visit to a doctor and pharmacy.

Like methadone, buprenorphine (pronounced byoo-pre-NOR-feen) is addictive, but the risk of overdose is much lower. Unlike methadone, buprenorphine will not give an addict more than a mild high no matter how large the dose, and it cannot be combined with opiates or other narcotics to get higher still. Users suffer fewer unpleasant side effects, and milder withdrawal symptoms when they stop taking it.

Notice how medically prescribed substitutes for heroin must be described as "blocking the addict's craving for the high," as opposed to offering a cheaper, safer way to get high. Martin, who notes that heroin was once marketed as a cure for morphine addiction, isn't buying it.

The Times reports that "the relative ease with which a supply of buprenorphine can be obtained is a radical departure from the use of methadone, which is tightly controlled by federal law and can be given only one daily dose at a time, in licensed clinics where space is limited." Martin adds: "This situation will last just as long as it takes for experts to discover, to their amazement, that 'addicts' like this new drug because it makes them high!" He cites a December 1 article from an Australian paper decrying diversion of buprenorphine to the black market.