Medicine: Can Drugs Cure Drug Addiction?

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When methadone was first introduced 24 years ago, it was hailed as a magic bullet aimed at the heart of heroin addiction. A neat, clean medical solution to a social problem. It has proved to be something less than that. Methadone is a treatment, not a cure, for addiction, and an imperfect one at that. But for some 100,000 of the country's half-million heroin addicts, it offers an alternative to shooting up as well as the possibility of a productive life.

With the crack epidemic spiraling out of control and the continuing threat of AIDS transmission through needle sharing, the research community and government leaders are showing new interest in medical approaches to drug addiction. After nearly a decade of relative neglect under the "Just Say No" Reagan Administration, the Federal Government has sharply increased funding to the National Institute on Drug Abuse, which sponsors almost all of the world's drug-abuse research. In the past year NIDA's medications and basic-research budget jumped 50%, to $75 million, and Congress promises similar increases in the future. "It's the Manhattan Project for chemists in the war on drugs," declares Duncan Taylor, a senior researcher at Bristol-Myers.

The most promising of several drugs to combat addiction that are being tested is buprenorphine, a pain reliever that in early trials has shown clear advantages over methadone as a treatment for heroin addiction. Under development by a team at Yale University, the drug, like methadone, induces a generalized feeling of contentment rather than heroin's precipitate rush and euphoria. It is at least as effective as methadone in easing physical withdrawal and reducing cravings, and it is significantly more potent in blocking heroin's high if the addict tries to shoot up again. Unlike methadone, buprenorphine is relatively nonaddictive and carries almost no risk of overdose. In one trial of 41 addicts on methadone maintenance, it cut the number of those who continued to take heroin to just over half and eased 18 off opiates altogether.

- As a bonus, buprenorphine seems radically to suppress the urge to take cocaine, which is abused by an estimated 70% to 80% of heroin addicts. Methadone also tends to reduce coke use, but less dramatically. While methadone may wean half of those treated from cocaine, buprenorphine could slash the number of coke abusers to almost nil, says Yale researcher Thomas Kosten. A Harvard study of rhesus monkeys habituated to using coke found that daily doses of buprenorphine led the monkeys to kick the habit completely.