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Services at the methadone clinic in the Nevada Treatment Center will be affected by new federal regulations overseeing treatment of opiate addictions across the country. Heroin addicts and those addicted to prescription painkillers should have better access to care and more treatment options under the new guidelines. Photo by K.M. Cannon. Medical supervisor Tonia Harris operates the methadone distribution window Friday afternoon at the Nevada Treatment Center, where take-home doses of the drug are given to those who comply with the center's rules. New federal rules should help increase access to treatment facilities and counseling for those addicted to heroin or prescription painkillers. Photo by K.M. Cannon.

Wednesday, February 21, 2001
Copyright © Las Vegas Review-Journal

Opportunity To Be Drug-free

New rules to let private physicians prescribe addiction medications

Feeding his heroin habit was as easy as buying a carton of milk, says a local addict who has been clean for six months despite the frequent gifts of dope from dealers desperate to get him hooked again.

The 46-year-old man, who only wants to be identified by his initials, B.L., has been drug-free because his daily doses of methadone curb cravings and help him remain strong.

"It's not easy staying clean because they know who you are, and they try to give it to you," said B.L. of the dealers who approach him on the sidewalk or honk their horns when they drive by. "They know once you start shooting dope again, they've got you calling again. It's hard to get help."

Now, at a time when Las Vegas addiction specialists report they are seeing a rise in heroin and prescription drug addiction, proposed federal regulations should make treatment both more accessible and comprehensive, allowing addicts such as B.L. increased opportunities for help and a better chance at remaining drug-free.

Under the new regulations, expected to be approved and in effect this spring, certified physicians will be able to prescribe buphrenorphine, a drug similar to methadone, to combat opiate addictions.

Both methadone and buphrenorphine are controlled substances, and currently only physicians at narcotic treatment programs are allowed to prescribe them to treat addicts.

The guidelines create a new accreditation program managed by the Substance Abuse and Mental Health Services Administration that replaces the Food and Drug Administration's 30-year-old inspection program.

"This will help get patients out of methadone clinics that have waiting lists and into a private physician's office for treatment instead," said Bonnie Carlisle, the program administrator for the Clark County Health District's Addiction Treatment Clinic, which treats about 185 addicts a year.

"The bonus is, patients will no longer have to go to a methadone clinic. It will remove that feeling of, 'Yuck, now I have to go hang out at the methadone clinic every day.' "

Buphrenorphine will be prescribed by doctors for addiction treatment rather than methadone because it has less potential for addiction, Carlisle said. She said most addicts referred to a private physician's office will have proven themselves in a methadone clinic beforehand, and they can be trusted to keep a supply of the drug at home and take it as directed only.

The Addiction Treatment Clinic is one of three state-funded methadone treatment programs in Southern Nevada.

Methadone has been used for more than 30 years to help heroin and opiate addicts function normally while dealing with their drug addiction. Daily doses of methadone help combat cravings and stymie the effects of heroin and other opiates if they are used during treatment.

"I've heard millions of times that I'm just trading one drug for another, but people don't understand," said recovering heroin addict Pauline Gonzalez, who has been taking methadone at the Addiction Treatment Clinic every day for more than two years. "The difference is, you can function on methadone. You don't get high, and your cravings stop. With heroin, you're high and sitting on the couch all day, and you can't do anything."

Doctors soon should have the power to prescribe medication to treat addicts, but whether local physicians will decide to take on the optional responsibility is unclear.

Dr. Michael Levy, a local addiction medicine specialist, has signed up for a certification class to prescribe the drug buphrenorphine, but he said he is not sure how many other doctors will be willing to do the same.

Also, he is concerned about who will end up paying for the doctor's visits and medication if insurance will not cover the bills or the patients cannot pay.

"The purpose for this is to allow for more access. A lot of people avoid getting help because of the requirement to go to a methadone clinic," said Levy, who sees 30 to 40 new patients a month for prescription drug abuse.

Keith Macdonald, executive secretary for the Nevada State Board of Pharmacy, said he hopes rural doctors sign up to prescribe the medication because addicts in Elko and Ely do not have access to methadone clinics.

"There are places with no treatment programs," Macdonald said. "I had a former heroin addict call me from Ely and say he didn't know what to do or where to go. I didn't know what to tell him."

Besides allowing doctors to prescribe addiction medication, the new regulations change treatment standards to include mental health services, counseling, vocational education and outreach programs to help mainstream addicts back into society.

"Patients who use heroin are really disenfranchised from mainstream society," Carlisle said. "You're looking at someone who is developmentally nine, 10 or 11 years old. Some of them have such basic social skills it often requires taking them out and showing them how to go shopping. You're talking about a population with tremendous needs."

Both B.L. and Gonzalez agree.

B.L.'s liver is rotting from hepatitis C after using a contaminated needle, and he must learn to monitor his health. Gonzalez is pretty sure she has the disease too but needs more testing.

They each need counseling services, often more than is offered and available.

"The counseling, that's what has helped me change more than anything," Gonzalez said. "It has made a huge difference in my life and my kids' life. They got their mom back."