Alexander DeLuca, M.D.
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New Drugs Promise Treatment For Addicts, Profits for Firms
by Peter Landers, Wall Street Journal (Personal Journal); February 20, 2003

Seven years ago, Steve, a chemical engineer in Texas, began craving painkillers. "You take three or four pills and you feel so good in just 30 minutes. ... It's like Christmas morning," recalls Steve, who didn't want his last name used for fear of losing his job.

Last month he found a new drug -- one designed to cure his addiction. Known as buprenorphine, it eliminates cravings for painkillers but isn't addictive itself. Patients can get the drug privately at a doctor's office; around 1,000 physicians have been certified to prescribe it.

Buprenorphine is the advance guard of what could be a revolution in addiction treatment -- one that allows people to discreetly get help from a family doctor in the form of a pill. Americans have long looked askance at the idea of treating a drug addiction with another drug, but that is changing as the federal government and a handful of young drug companies search for treatments to help people addicted to alcohol, painkillers, cocaine and heroin.

The current search for an addiction treatment reminds some experts of the shift in attitude towards depression in the early 1980s. Many people then thought of depression as a character flaw, but pharmaceutical companies and doctors had begun to view it as a disease that could be treated with drugs. Today, that view is widespread, and antidepressants are a $16 billion world-wide market -- and growing.

"The industry has begun to wake up that this is a therapeutic area in which progress can be made and profits can be made," says Henry Kranzler, professor of psychiatry at the University of Connecticut.

Addiction is one of America's biggest public-health problems, with an estimated 14 million adults suffering from alcoholism or alcohol abuse, and millions more abusing hard drugs such as heroin. Still, treatment remains confined mostly to counseling or psychotherapy.

Doctors also are studying a couple of drugs geared toward helping alcoholics kick the habit. One, called naltrexone, has already been approved for use in the U.S., though there is disagreement over how, and how often, to administer it.

Far from a simple medical issue, many Americans see addiction as a legal, even moral problem, and for most of the 20th century, doctors shied away from treating addicts. Groups such as Alcoholics Anonymous, blending self-improvement with a quasi-religious fervor for abstinence, filled the vacuum. The view of addiction as a crisis of willpower was crystallized in Nancy Reagan's "Just Say No" campaign in the 1980s.

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Safer Than Methadone

Buprenorphine turns on the same receptors in the brain's neurons as opiate drugs, which include prescription painkillers. Unlike other opiates, however, buprenorphine isn't highly addictive and doesn't produce a powerful high.

Some specialists object to replacing one drug with another, but that view is changing. Currently more than 170,000 Americans who are addicted to opiates are treated with methadone, which also is a primary treatment for the growing problem of painkiller addiction.

Buprenorphine, sold in pill form, is less addictive than methadone and also less dangerous if users overdose. Unlike methadone, which is distributed mostly at special clinics, buprenorphine is administered in doctor's offices. It also is much harder to sell on the black market because it causes withdrawal symptoms if users inject it seeking a high.

Peter, a 22-year-old New Yorker who works in the computer industry, became addicted to painkillers as a teenager, then graduated to heroin. For two years, he flew to France to get buprenorphine, but recently got a prescription from a doctor at home for the first time. The drug stops cravings so well, he says, "you tend to forget that you have a problem."

Buprenorphine, which like all addiction drugs, works best in combination with behavioral therapy, isn't right for everyone. Patients on buprenorphine can use it safely for as many years as the addiction exists, doctors say; those who want to stop can gradually reduce the dose. Doctors need eight hours of training and a special certification to prescribe buprenorphine.

Progress in treating addictions to other substances has been slower, but is building. Naltrexone, the main approved medication for alcoholism, has been on the market since 1995, but the pill has to be taken daily, a discipline recovering alcoholics find hard to achieve.

DrugAbuse Sciences Inc., a privately held Hayward, Calif., company, now is testing a naltrexone dose that would be injected once a month in the patient's buttocks at a doctor's office. After more tests, the company expects next year to seek government approval to sell the drug.

Alexander DeLuca, a New York doctor who has treated alcoholics -- and has clashed with proponents of abstinence -- recommends an alternative use of naltrexone. The drug should be taken before craving strikes, he says, such as before a party. Studies suggest the drug retards the mild euphoria of a drink, helping alcoholics imbibe moderately.

Many had expected another medication for alcohol abusers, called acamprosate, to be available by this year. Widely used in Europe, where studies have shown it works better than a placebo in cutting drinking, the drug has failed to gain approval from the Food and Drug Administration because of inadequate data. The drug's maker, Merck KGaA of Germany, no relation to U.S.-based Merck & Co., says it plans to resubmit its application to the FDA in May.

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Cocaine Vaccine?

The FDA has yet to approve any medication for cocaine addiction, but several major studies are under way. The National Institute on Drug Abuses is now studying whether selegeline, a drug approved for Parkinson's disease, can help cocaine addicts. Results are set to be revealed in a few months. In addition, Britain's Xenova Group PLC is working on a vaccine designed to create antibodies that would attack and destroy cocaine molecules before they could get to the brain. Research is still at an early stage, and even if successful, the drug wouldn't hit the market for many years.

Frank Vocci, the head of medication development at NIDA, puts all the drugs now available for addiction in the "first-generation" category. Medications that can actually reverse the effects of powerful drugs of abuse are at least "eight years-plus away," he says. "I don't see something happening much faster than that."


Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D., FASAM.

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Originally posted:  2/23/2003

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