On the second floor of a battered detox facility deep in Portland's heroin zone, a little white pill is blunting the misery of withdrawal and revolutionizing the treatment of opiate addiction--all for $5 a dose.
"It's been a huge change," says James Nicholas, a counselor at the Hooper Center, on Northeast Martin Luther King Jr. Boulevard and Couch Street, a gritty neighborhood where junkies nod in cafes and dealers ply their trade in the open air.
Buprenorphine (pronounced BYOO-pruh-NOR-fin) is widely used to treat heroin addiction in Europe but has only recently come into vogue in the United States. It was first approved by the U.S. Food and Drug Administration in October 2002, and Hooper has used it for just two months
The Portland detox center is one of the first in the U.S. to employ the drug to wean addicts from the needle.
Local statistics are hard to come by, but clients at Hooper told WW the drug has dramatically quelled their cravings.
"Oh, man, it's the easiest kick I've ever done," says Ann, 31, who, like all addicts quoted in this article, used a false name.
"This is like a miracle medicine for addicts," says Barbara, 51, who has been a junkie for more than two decades.
As it happens, buprenorphine is not a new drug. It was synthesized more than 30 years ago by chemists working for Reckitt & Colman, a British consumer-goods company whose other products include Worcestershire sauce and Lysol. The drug was originally intended as an alternative to aspirin, but in recent years researchers have recognized its potential as a treatment for heroin addiction.
"It's probably the biggest development in the last 30 years," says psychiatrist Dr. Josh Boverman, an assistant professor at Oregon Health & Sciences University.
Like pieces in a jigsaw puzzle, buprenorphine molecules fit into the same receptors in the brain as heroin, cushioning withdrawal symptoms.
At Hooper, buprenorphine therapy lasts seven days--the time when the symptoms of heroin withdrawal are most severe. During this time, addicts wearing hospital smocks shuffle from group therapy to acupuncture to dorm-style beds as they wander the psychic no man's land of detox.
With buprenorphine, however, these addicts seem more chipper than you'd expect. When he heard WW planned an article on buprenorphine, an addict named Ramon buttonholed a reporter with the verve of a used-car salesman.
"This is saving my life," he says.
Ramon, 46, had tried to detox from heroin at Hooper three times before, but could never stick to the program. "The intensity of the withdrawal was too much for me," he says. "I had to escape."
This time was different, he says, thanks to buprenorphine: "I want people to know they don't have to go through the pain and anguish. There's something that can save their life."
Besides helping junkies get clean, buprenorphine can also be used to help them stay clean.
Heroin's gravitational pull is so strong that some addicts never escape it. No matter how many times they kick the habit, they always wind up back in the bag.
For several decades, the only treatment for them was methadone--a controversial substitute for heroin that is more addictive but less pleasurable.
Buprenorphine offers several advantages over methadone. First, it's far less addictive. Junkies say methadone is harder to kick than heroin and produces a fearsome withdrawal. Buprenorphine produces mild symptoms at worst.
Second, buprenorphine is far less deadly. In 2002, 103 Oregonians died of methadone overdose--two more than succumbed to heroin. In contrast, medical literature reports few buprenorphine fatalities.
Third, buprenorphine is available by doctor's prescription, unlike methadone, which must be dispensed through special clinics.
"Buprenorphine has about the same efficiency as methadone, but clients like it better," says Dr. James Thayer, medical director of Hooper.
"I was back to my old self," says Susan, 44, a high-tech executive, recalling the time last year when she switched from methadone to buprenorphine. "I was happy as a clam--walking around the office singing to myself again."
Buprenorphine does have some drawbacks. It's more expensive than methadone, it's not yet covered by the Oregon Health Plan, and some addicts can't stay clean without the ritual of going to the methadone clinic every morning to drink their medicine from a paper cup.
The advent of buprenorphine also poses a philosophical question. True, more junkies will seek treatment if they can avoid the naked terror of unmedicated withdrawal. But do they need that terror in order to stay clean?
"That's like saying, 'We don't want people to be too comfortable with their surgery,'" says Tim Hartnett, executive director of the local drug and alcohol treatment agency CODA, which is conducting a study of buprenorphine.
"The suffering of detox has never been enough to keep people clean," says Thayer. "People get clean and stay clean because of the suffering of drug abuse. They get abscesses, they get hepatitis. They get tired of spending all their time, energy and money chasing the next bag."
Find out more about buprenorphine at buprenorphine.samhsa.gov . Find out more about Hooper Center at www.centralcityconcern.org , or call (503) 238-2067.