New detox drug offers renewed hope
By Michelle Hillman / News Staff Writer

Dr. Mashallah Ezzati is one of three physicians in MetroWest prescribing buprenorphine -- a new drug given to addicts in a doctor's office -- and believes it will revolutionize addiction treatment.

The Framingham physician began prescribing the painkiller to patients two months ago when he opened his home office, and said people suffering from serious addiction to opiates, such as heroin, morphine and some painkillers, had cravings wiped away using the drug.

"Most of the time they say, 'We are normal for the first time in many years,'" he said.

Buprenorphine was approved by the Food and Drug Administration last October and was on pharmacy shelves in January. It became legal for physicians to use the controlled substance in primary care settings in 2000.

In order to prescribe the drug, which is called a schedule 3 substance, physicians must be certified by the Substance Abuse and Mental Health Services Administration, or SAMHSA, a federal agency under the Department of Health and Human Services.

Ezzati, who has specialized in addiction treatment for at least a decade and has been certified to prescribe buprenorphine for six months, said patients he is treating have fewer withdrawal and craving symptoms and are able to function better than when on methadone.

He has patients coming from Vermont and New Hampshire and has treated about 50 people. The treatment takes two to three months but is not limited to a particular time frame.

"My experience in the last two to three months is totally different than the past," he said.

On Nov. 22 the Massachusetts Medical Society and Boston Medical Center will offer a course for physicians interested in prescribing buprenorphine. Any physician, regardless of specialty, can prescribe the drug if certified.

Dr. Daniel Alford, a physician at Boston Medical Center who has been prescribing the drug since June, said people have "come out of the woodwork" looking for the drug.

The drug is given in an outpatient setting instead of a detox center, and has attracted drug users who are not willing to enter a detox program.

"We've got lots of young 20-year-olds who are new in their addiction," he said. "They failed detox. They went through detox and relapsed. Now there's a new option."

Under the law physicians can only have 30 patients at one time, said Alford. The medication is covered by the state's Medicaid program.

Michael Botticelli, assistant commissioner for Substance Abuse Services at the state Department of Public Health, said early indications in a pilot study being conducted at the Boston Medical Center show buprenorphine is a promising treatment option for addicts.

"It's just beginning," Botticelli said. "This is not a silver bullet. Any opportunities to expand treatment capacity in our system are welcome."

Many physicians are nervous about prescribing the drug, especially if they are not addiction specialists, Botticelli said.

"You're not going to find your general family doc saying, 'Hey I think I'm going to use buprenorphine,'" he said.

Alford said he has developed a mass e-mail service for physicians who have questions once they start prescribing the drug.

"There's definitely a fear about treating this population," he said. "Can they do it in their practice? It's a new area so physicians don't feel comfortable."

Sara Hartman, vice president of mental health services at the Mental Health and Substance Abuse Corporations of Massachusetts, said addiction service providers have mixed feelings about the drug, which is not appropriate for people with long-term addiction, she said.

"Medication alone is not sufficient to help people with an addiction problem," she said.

Buprenorphine is safe from abuse because after it is used for a certain duration of time, the effects of the drug plateau, she said. It does not have to be taken every day in the same way as methadone because it has longer-lasting effects.

While it is another option, Hartman is not sure it will dramatically change addiction treatment.

"I don't know that it will create a sea change," she said. "I think the stigma about addiction, particularly opiate, is very strong. I think people are hopeful this will help reduce that stigma."

Back to articles