- Fanfare surrounding this week's opening of Vermont's first methadone program comes in the wake of the federal government's approval of an alternative to the long-standing heroin addiction treatment.

The Food and Drug Administration approved the use of buprenorphine to treat opiate addiction. The drug is considered safer than methadone and could be dispensed by prescription in the privacy of a doctor's office.

Methadone, by contrast, is among the nation's most regulated drugs. When used to treat heroin addicts, methadone must be dispensed from a center approved by the Drug Enforcement Administration under strict security guidelines.

"There are potential benefits to both, there are potential drawbacks to both, all the better to have multiple medications available," said Dr. Warren Bickel, interim chairman of the University of Vermont's psychiatry department.

Bickel is director of the Burlington methadone clinic and has studied buprenorphine as a substance abuse treatment at the University of Vermont for more than a decade. The two treatment programs share a wing of the University Health Center in Burlington.

Both drugs block withdrawal symptoms and curb cravings for the drug. A patient might be best suited to one or the other based on the severity of the addiction.

Methadone's effects on a patient increase as the dose increases, Bickel said. Buprenorphine's impact on a patient eventually hits a ceiling, he said. Buprenorphine is considered safer as a result.

A patient can take several days' worth of buprenorphine at once, Bickel said. Patients in his experimental program received up to four days' dosage at a time. Methadone must be taken daily, so patients at the new Burlington clinic must visit seven days a week.

Both drugs are taken orally.

Bickel said buprenorphine has drawbacks. Because its effects are limited, buprenorphine might not be sufficient to treat addicts with very high tolerance for opiates, he said.

FDA approval will not affect the existence of the experimental buprenorphine program Bickel runs at UVM. He said the study has shifted its focus from the drug itself to how the drug can be administered to treat addiction.

Contact Cadence Mertz at 660-1847 or cmertz@bfp.burlingtonfreepress.com.
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