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New drug fights
opiates addiction
Buprenorphine can be prescribed
by 10 isle physicians who
have advanced training
A little pill that melts under the tongue is a promising new treatment for heroin addicts and people dependent upon painkillers, say island physicians certified to prescribe it.
Buprenorphine, available under the trade names Subutex and Suboxone, "is a whole new ballgame," says Dr. Kevin Kunz of Kona, specialist in addiction and pain management.
They are the first drugs approved by the Food and Drug Administration that can be prescribed in a doctor's office to treat opiate dependence. Others, like methadone, can only be dispensed in addiction treatment clinics.
Suboxone, like Subutex, contains buprenorphine hydrochloride but also has an ingredient called naloxone to guard against misuse, according to the FDA. "It's a marvelous improvement over methadone," Kunz said.
While aimed primarily at treating addiction to heroin and other street opiates, he said the medication also works for withdrawal and treatment of people dependent on prescribed opiates, such as Vicodin, Anexia, morphine and OxyContin.
Overdose and side effects of buprenorphine are minimal, and it doesn't make users high, he said. "It is very controlled."
However, physicians can't prescribe it without medical education in addiction, which hasn't been available here, Kunz said. Only 10 Hawaii doctors are qualified to prescribe it, he said.
The number of patients on Suboxone is restricted to 30 per physician, so it won't be generally available for treatment here until more doctors are trained, Kunz said.
An eight-hour course will be offered during the Hawaii Medical Association's annual meeting Sept. 2-5 at the Sheraton Waikiki.
The American Society of Addiction Medicine, represented by Dr. Donald Wesson, noted researcher in addiction care, will present the training Sept. 3 for continuing education credit.
Wesson, Kunz and Dr. Gerald McKenna, Kauai psychiatrist and past HMA president, will be among speakers addressing physicians' health and chemical dependency in sessions Sept. 4.
McKenna, who has been prescribing buprenorphine for 15 months in a drug outpatient treatment program, said it's "a very useful adjunct in treatment of certain people with narcotics dependency."
It allows them to get off narcotics much easier as an outpatient than if they have to go to a hospital for detoxification, he said.
Those who can't stay off narcotics can go on a low-dose buprenorphine maintenance program instead of buying street narcotics or using methadone, "which we don't have on Kauai and many people resist going to," McKenna added.
Dr. William Haning III, also certified to prescribe buprenorphine, said, "It's an excellent medication in many respects" and a "really needed option" for people with heroin or other opiate dependencies.
But it doesn't cure anyone's addiction, cautioned Haning, principal investigator at the Pacific Addiction Center, UH John A. Burns School of Medicine, and medical director of Behavioral Health Services at the Queen's Medical Center. "You don't treat pneumonia just with an antibiotic."
‘Miracle’ cited against
heroin and painkillers
Two Kona patients of Dr. Kevin Kunz, a specialist in addiction and pain management, say a new product prescribed for drug addiction or painkiller dependence has changed their lives.
"It is kind of a miracle of science as far as I'm concerned," said Caleb Pepperworth, 25, an intravenous heroin addict now on a buprenorphine medication called Suboxone.
"It's the one thing that really made it possible for me to push forward with my recovery, detox from harder drugs and get my life back on track," he said.
Joyce Jordan, 60, who has suffered with persistent pain from a lower back injury in 1981, said: "I had gone through every pain medication there is, except heroin. ... Nothing worked."
She underwent multiple tests, procedures and surgery, but the "pain was escalating tremendously," she said.
She became dependent on up to 1,500 to 1,800 milligrams a day of the painkiller OxyContin, a form of synthetic morphine, prescribed by another doctor.
"I was so addicted I ended up in the hospital a lot of times," she said.
After going to Kunz late in 2001, she went into the hospital for a week, and he slowly transferred her from OxyContin to methadone, she said. He then gradually withdrew her from that. "It was horrendous," she said.
Once she was in complete withdrawal, he started her on 6 milligrams of Suboxone Feb. 18, and "immediately the pain went away," she said. "It was like somebody stopped hammering you with a hammer, and it felt so good."
He saw her twice a day for a week and continued close monitoring, even giving her his cell phone number to call any time she was hurting, she said.
She must limit her physical activities and probably will need more surgery, she said. But she can manage the pain with a 2-milligram Suboxone pill whenever needed, she said.
"It's a wonderful medication. I can't imagine how many people this is going to affect and let them have a life of quality."
Pepperworth, formerly of Bellingham, Wash., said he had used drugs since age 14 -- everything from marijuana and mushrooms to finally mixing cocaine and heroin. He went back and forth from benders to recovery. "I could never really break the cycle."
He joined his parents in Kona about 1 1/2 years ago. "I was really dope-sick. In Seattle, I had lost everything, my home, my wife. I was doing 4 to 5 grams of black tar heroin a day and probably 1.5 to 2 grams of coke."
He said he went to see Kunz in July 2003. "I was very sick. He gave me Suboxone, and within 30 minutes I was up on my feet, walking around. ... I've been clean ever since."
Kunz worked with different dosages to find the right level for the patients, required them to attend Suboxone classes and has closely monitored them.
Pepperworth had an emergency appendectomy last week in Kona Community Hospital without any narcotics. He said he was hurting when he arrived because he hadn't taken Suboxone. "As soon as they started administering it, I felt 100 times better."
He and his ex-wife now have "a great relationship," and he's back to his plumbing profession. "I feel great, back to normal," he said.
