New drug liberating addicts

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For one addict, it took only four months to become hooked on heroin, and it’s taken him years to get clean.

The 23-year-old man, who asked to remain anonymous, eventually hit the lowest point of his life – an overdose that almost claimed his life and nearly led him to suicide. His mother, who had always been supportive and loving, told him she couldn’t have contact with him until he beat his addiction. It hurt her too much.

He didn’t think he would be able to escape his addiction. He was liberated from it by another drug – buprenorphine – which has kept him clean for the last three years.

He gets his prescription for the drug at the Recovery Center at Mercy Westbrook, which until recently was turning addicts away because federal law restricted the number of patients a doctor could treat with the drug to 30. The center is now expanding its buprenorphine program, after Congress passed a new law in December allowing doctors to treat up to 100 patients with buprenorphine. Between two on-site physicians and other doctors the center works with in the community, Mercy expects to begin treating up to 400 patients.

“I’m having to turn people away every week. It’s tragic to have to turn away a 20-year-old because the practice is full,” said Dr. Mark Publicker, the medical director at the Recovery Center. “I think it’s going to expand the number of people that get treated in Maine by the thousands, which is a big deal.”

Until a few years ago, methadone was the only drug approved by the U.S. Food and Drug Administration for use in treating opiate addicts, whose bodies have become physically dependent on opiates and who can’t function normal lives without medicinal help. In 2002, buprenorphine, already used in Europe for years, was approved as a second drug to help opiate addicts kick. However, doctors with special training were allowed to treat only 30 patients at a time with the drug.

Buprenorphine, like methadone, attaches itself to the same receptors in the brain as opiates and mimics their effects. By doing so, it eliminates the painful and often debilitating withdrawal symptoms that make it nearly impossible for most addicts to quit using opiates.

In its most common form, under the brand name Suboxone, buprenorphine is coupled with naloxone, an anti-abuse drug that causes withdrawal symptoms if an addict uses an opiate while taking it. In effect, the addict can’t get high using an opiate while taking Suboxone. More importantly, however, Suboxone eliminates the withdrawal symptoms and cravings that could cause an addict to use again. Unlike methadone, which is commonly prescribed at a clinic and given in dosages in liquid form, buprenorphine is prescribed in pill form.

The physiology of opiate addiction

Addiction to opiates such as heroin, morphine, codeine and oxycodone causes prolonged and sometimes irreversible changes in brain function that result in a 90 percent relapse rate among addicts. Along with months of painful physical and mental withdrawal, an addict may lose his or her ability to experience pleasure. Using opiates creates euphoria and sedation of pain, while withdrawal causes depression and agitation along with the physical symptoms that can create cravings.

“That’s the thing about opiates. It only takes a very short period of time with regular abuse for any of us to become addicted,” said Kimberly Johnson, director of the Maine Office of Substance Abuse.

In the case of the 23-year-old addict at the Recovery Center, it was only about three or four months. Because he came from a loving, middle-class family, he believes anyone can become addicted to opiates. He was first introduced to them in high school during the mid-1990s, a period that saw the resurgence of heroin and the introduction of OxyContin, a powerful narcotic used to treat pain in pill form.

According to Publicker, who is president of the Maine Society of Addiction Medication in addition to being the medical director at the Recovery Center, the introduction of OxyContin created an explosion in opiate use, particularly in the five New England states, which have the highest rates of opiate use in the nation. Maine statistics count the number of medical admissions for non-heroin, non-methadone opiates at 85 in 1995. That number was five times higher in 1999 and 15 times higher in 2002.

It was during the mid-1990s, when he was 17 and had just finished high school, that the now 23-year-old addict was given heroin one day by an acquaintance. While he had tried other drugs before, including alcohol, marijuana and amphetamines, he said the first time he snorted heroin it was different. He said it felt like something he could do every day.

“During that time, I didn’t realize what was happening,” he said. “I was doing it more and more because it was around.”

Over the next three to four months, he regularly used heroin, which at the time was resurging as an inexpensive drug. Then he wasn’t feeling well and mentioned it to an acquaintance. That acquaintance, a long-time user of heroin, asked him a few questions about how he was feeling, which he said felt similar to having the flu. The acquaintance told him he was suffering from withdrawals.

“The guy said, ‘Welcome to the world of being a smack addict,'” he said.

Life as an addict

His heroin habit lasted about a year. During that time, he said using heroin was the only thing that he cared about. If he was waiting on a “shipment,” as he called it, someone might call him at 1 a.m. to say it was in, and he would wake up at 6 the next morning to pick it up.

His heroin addiction ended when a therapist he was seeing for depression threatened to tell his parents if he didn’t. He said he told his parents in a session, and when they found out, they were crushed. Although they had thought he might be an alcoholic, they hadn’t expected he was a heroin addict.

The effect of telling his parents put him on the road to recovery, although that road would take another two or three years and a number of attempts before it would end.

The first attempt was a month-long stint at a rehabilitation center in Pennsylvania, where he was expected to recover without the use of methadone, the only drug available at the time for treating addicts. He said the withdrawal was “miserable,” like a “really, really bad flu,” where he couldn’t eat, his muscles were always tense, he got the sweats and he was in a constant state of anxiety.

“Sometimes it feels like the insides of your bones ache,” he said.

When he returned to Maine, he said he wasn’t at all convinced that he could quit. The day he got back he said a friend gave him a handful of oxycodone pills as a welcome-home present. From that moment he began using prescription opiates, trading one addiction for another.

Another attempt

His second attempt at recovery came soon after when he began treatment at Cap Quality Care, a methadone clinic in Westbrook. He said the methadone enabled him to stay clean for six months. At the same time, he attended Alcoholics Anonymous meetings, saying he would have preferred Narcotics Anonymous, but meetings for addicts were rare in those days.

After six months, though, he went off the methadone to try to be clean without it because he didn’t think it was the right thing for him. He said methadone made him feel groggy and made it difficult for him to function normally.

The withdrawals from that were worse than the withdrawals from heroin. He said he began to drink alcohol heavily, and although he knew it was trading one addiction for another, it was better because he wasn’t strung out.

It wasn’t until his dad offered to find him a regular job that would enable him to get an apartment with his girlfriend at the time, who was also an addict, that he cleaned himself up. He started work and moved with his girlfriend into an apartment.

However, in the apartment building where the couple lived were a number of opiate addicts, including a dealer. For opiate addicts attempting to live clean, being surrounded by the thing they were trying to avoid was too much. They both began using again, this time mostly prescription opiates. They tried several times to quit but were unable to.

Eventually, he was injecting oxycodone intravenously, a more direct way to enter the drug into the blood stream that intensifies but shortens the duration of its effects. He said his addiction became as bad as it ever was.

He hit bottom after he broke up with his girlfriend and overdosed on a mixture of drugs and alcohol. He said he was lucky, because someone in the apartment got him medical attention. But a week later, he was on the phone with his mother telling her he wanted to commit suicide. She told him he was hurting her too much for her to continue contact with him unless he overcame his addiction.

Final recovery

“By this point I had inside of myself the feeling that most, if not all, addicts feel at some point – the feeling of disgust and self-hatred,” he said.

He began treatment at the Recovery Center at Mercy Westbrook on what was a relatively new drug at the time – Suboxone. He said he wished it had been around during his first rehab a couple years before because he thought it could have helped him.

“Instantly, when I was put on the medication I felt better,” he said.

Combined with counseling, Suboxone freed him from the addiction that had haunted him for the last three or four years. And he said he didn’t feel any of the stigma associated with going to a methadone clinic every day to receive his drugs. This way, he gets a prescription from his doctor that he takes to a pharmacy, just like everybody else.

He also doesn’t feel the groggy side effects as he did on methadone. He said he can function now and do the things he needs to do in his life without looking and feeling like an addict.

“It’s not a magic bullet, but it really freed my mind to work on what I needed to do,” he said.

But while he sings the praises of Suboxone, he’s also quick to say that he respects what methadone does for other people. It didn’t work for him, but he knows it works for others.

According to Johnson, he falls into the category of addicts that Suboxone is designed to help – younger addicts who have been addicted for relatively shorter periods of time. For someone with a 20-year addiction, methadone is a better choice because it’s a stronger drug.

Katie Clark, program manager for the Discovery House clinic in South Portland, which provides both methadone and Suboxone, said the drug prescribed depends on the addict. If someone has a longer addiction and needs the support of a daily trip to a clinic, methadone would likely work better. However, if someone doesn’t have as strong an addiction and is more self-sufficient, Suboxone would be the better choice.

“We’re talking about an ever-changing virus,” said Clark. “It looks different for everybody.”

Withdrawal symptoms are less severe from Suboxone and the likelihood of overdose is significantly less. Neither Johnson nor Publicker were aware of any overdoses on Suboxone since its introduction three years ago. Methadone, however, has been linked to scores of overdoses in cities in Maine and across the country.

The selling of methadone on the streets is considered a major problem, according to Westbrook Police Capt. Tom Roth, who said he could remember at least 10 deaths associated with methadone when he first came to Westbrook five years ago.

Johnson said methadone is the most common drug identified in toxicology reports of people who have overdosed on drugs in Maine, although the overdose is often associated with mixing methadone with other drugs. She said with Suboxone it’s not really an issue because the anti-abuse drug in Suboxone causes the user to go into withdrawal if another opiate is entered into their system.

Suboxone also has a ceiling effect, whereby taking more of it won’t have any greater effect – addicts can’t get higher by taking more. Additionally, with methadone, which is often given in liquid form, it’s difficult even to tell how much a person on the street is getting. That alone leads to many overdoses, said Johnson.

For professionals like Johnson and Publicker, Suboxone fills a niche that is strong in Maine because many of Maine’s opiate addicts are between the ages of 18 and 25 and have been using for a relatively short period of time. It also enables treatment remotely because addicts don’t have to go to a methadone clinic every day to get their drugs, which is particularly important for a large, rural state with few clinics, like Maine.

While the drug has been around since 2002, Johnson said Maine is still a forerunner in treatment with it. She said the state currently has the highest number of physicians per capita – about 200 – who have taken the training required to prescribe it. In September, she said, 124 physicians wrote 1,200 prescriptions for Suboxone.

Now, with the new congressional legislation, physicians like Publicker will be able to treat addicts who they previously had to turn away. Publicker said it will have an immediate impact on Maine’s untreated opiate addicts, which he said could number over 30,000.

A future

For the 23-year-old addict, Suboxone may have saved his life. He said most of the people he knew while using are either dead or in jail. He is now earning a degree at a community college, where he is studying business and has a 3.87 grade point average. He plans to attend a four-year school for business and one day start an independent music label.

He doesn’t know how long he’ll have to stay on Suboxone. Often, opiate addicts are told they might have to stay on methadone for life. It’s not clear how it will be for him with Suboxone, but he’s not worried about it at the moment. For now, it’s helping him, and that’s what’s important. He said he’s serious about his future and doesn’t plan to go back.

This past Christmas, he said, his mother told him it was the first time during the holidays that she felt he would never go back. He said she told him she felt like she had her son back.

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