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Suffolk adds Suboxone to fight against heroin

Bags of Heroin are sold individually or in

Bags of Heroin are sold individually or in a pack of 10 known as a "deck." (June 12, 2009) Credit: Patrick E. McCarthy

Targeting Long Island's growing number of young addicts, Suffolk officials say they will up the ante in the fight against heroin with a new public health initiative.

In his State of the County address next week, Suffolk County Executive Steve Levy will announce that buprenorphine - an anti-opiate addiction drug sold under the name Suboxone - will for the first time be dispensed at a county clinic. Patients in the pilot program will also receive long-term counseling, which addiction specialists say is a critical but often mismanaged part of recovery. A state official said the program's combination of prescription medication and counseling makes it the first of its kind in New York.

"The Suboxone and . . . ongoing counseling will provide a hope to some for whom it didn't exist before," said Thomas MacGilvray, director of Suffolk County's Community Mental Hygiene Services. The $350,000 commitment will support only 60 patients, but will be charged on a sliding scale and be expanded if demand overwhelms the pilot program, he said.

Suboxone, a drug designed to reduce cravings and heroin's withdrawals, can be taken at home. Unlike methadone, typically given to chronic opiate abusers, Suboxone can be given to adolescents without a waiver.

In the past three years, treatment center, school, and law enforcement officials have seen a rising tide of potent heroin being used across the Island. The number of overdose deaths has risen in both counties, and heroin-related arrests are up dramatically. Suffolk treatment centers saw a fivefold increase in admissions of heroin-addicted adolescents between 2006 and 2009.

State and local addiction experts applauded the program but warned Suboxone is not a magic bullet for heroin's addictive hold.

While many methadone clinics also distribute Suboxone, no other public program also provides comprehensive counseling and subsequent doctor referrals, said Steven Kipnis, medical director of the state Office of Alcoholism and Addiction Services. With private doctors, "there is no absolute mandate you have to link your patients to addiction services and that's the weak link," he said.

Suboxone is currently being prescribed by 238 licensed doctors on Long Island, up from 123 in 2007, according to the National Alliance of Advocates for Buprenorphine Treatment, an industry-supported group. The drug costs an average of $12 to $14 a day, and is usually taken for a minimum of six to 12 months. Doctors can charge up to $500 for the initial visit, with additional costs for later visits.

Levy said the program was inspired in part by the frustration of parents about a lack of treatment options, costs, and difficulties getting insurance coverage. If it proves successful, he said, federal and other money could be found to expand the program.

MacGilvray said patients will receive the tablets daily under supervision for up to a month at a single Suffolk clinic, then transition to an outpatient program for six to nine months. Patients may be weaned from the drug during that period or referred to an outside doctor as needed.

A nurse and two counselors will be hired to run the program. The program will bill Medicaid and private insurers when possible. "No one is going to be turned away because they can't pay," MacGilvray said.

Buprenorphine
Suboxone is a narcotic designed to reduce cravings and allow the addict to focus on behavioral changes. Users typically take the drug for several months before beginning a medically managed tapering off.

 >> PHOTOS: Click here to see photos of the impact of heroin on Suffolk

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