http://www.nydailynews.com/clean-breakthrough-new-methadone-substitute-grade-article-1.800120

Medication Assisted Treatment Wars

4 min readMay 17, 2018

A CLEAN BREAKTHROUGH NEW METHADONE SUBSTITUTE MAKES THE GRADE

By SUSAN FERRARO

NEW YORK DAILY NEWS

JUN 29, 1998 | 12:00 AM

http://www.nydailynews.com/clean-breakthrough-new-methadone-substitute-grade-article-1.800120

A substitute for methadone is making its way into drug-treatment programs and changing the way doctors and patients treat addiction. Called LAAM, the drug is better than methadone, say New York Veterans Affairs doctors, because it is easier to administer, and unlike methadone has no street value. LAAM patients don't report getting a "buzz" from it, says Dr. Paul Casadonte, who heads the drug programs at the New York Veterans Affairs Medical Center, where he has studied the medication in more than 400 patients since the early 1990s. "They think we are giving them sugar water, and they go out and try heroin and nothing happens.

" LAAM short for levomethadyl acetate hydrochloride and marketed as ORLAAM by Roxane Laboratories Inc. is a synthetic that works like methadone to prevent heroin highs and lows by blocking the brain receptors that would otherwise hook up to the illegal opiate. The body metabolizes it slowly, which means that it has to be taken only three times a week. That makes it more convenient and easier to work into a back-to-normal, non-using lifestyle than methadone, which must be taken every day. "LAAM gave me an opportunity to grasp the life I was supposed to have," says Luis B., an addict who had failed to kick the drug habit that had cost him decades in time, two wives and jobs beyond counting. "The material stuff? Forget it. But I lost friends," he says. Back to normal A Brooklyn butcher, Luis, 42, started sniffing glue when he was 9. He went on to marijuana, acid, mushrooms, codeine, cocaine, alcohol and heroin. He used through marriage, fatherhood and an Army stint in Korea. He always went back to heroin, even when he was on methadone, which for a long time was the only available substitute therapy. LAAM is "better than meth, because it doesn't get you drowsy, numb, stupid," Luis says. "I been on it going on five years. I don't get high. I don't drink. It is like a different Luis.

" A Veterans Affairs study shows that addicts on LAAM are less likely to start "chipping" using heroin while in treatment than those on methadone. Of 200 patients in an Illinois program, 81% of those on LAAM stayed clean at least three months, compared to 60% of methadone patients. They are more likely to stay in treatment than methadone patients, other studies show. Addicts who take LAAM are also more likely to work toward becoming completely free of drugs, says Casadonte. "LAAM patients don't feel hooked, so they want to get off it, [whereas we] have some people on meth who have been using it 25 years some highly functioning, but bottles will disappear," Casadonte says. Approved in 1993 LAAM was created and found safe in the 1970s, Casadonte says, "but in the 1980s it was shelved for unknown, possibly political reasons.

" Interest revived in the early 1990s, and Casadonte was one of the first to test it at the VA. The FDA approved it for use in addiction-control programs in 1993. Convincing the medical establishment that LAAM works as well as, if not better than, methadone has taken longer. Only 3,000 patients in the country have been on it. The reason is that LAAM is initially more complicated to use than methadone, "and people are scared of something new," says Casadonte. The full effect of the drug is not felt immediately, and it can take several weeks for patients to stabilize on it. Mixing LAAM with other drugs or alcohol can be serious even fatal especially at first, when adjusting dosages, or after a lapse in treatment. Less serious side effects include constipation and sleep problems at first and temporary loss of sexual function. "The people who seem not to like it are people who have co-existing psychiatric disorders, especially if they are using and abusing benzodiazepines like Valium," Casadonte says. To promote wider use of LAAM, Casadonte surveyed patients in January. Two-thirds of those who had used LAAM preferred it because "they had to come to the clinic less frequently, they felt more normal, it avoided the negative reputation of methadone [and] they stabilized fairly quickly," Casadonte says. "It is more expensive than heroin, milligram per milligram," but if you factor in lower nursing costs and reduced costs to the patient coming into the clinic, it evens out, Casadonte says. "If you can put somebody`s life back on track, it's not expensive.

" Sidebar: FAST FACTS An estimated 586,000 Americans reported using illegal drugs at least once a week in 1993. Heroin dependence can develop in two to three days of continued use. One methadone dose can protect from about eight heroin hits. ORLAAM is the first new opiate-addiction therapy in 25 years. Beyond withdrawal: Drug-abuse complications can include viral hepatitis, bone infections, pneumonia, abscesses, greater risk of HIV, neurologic problems and coma, brain infections and blood clots. Babies carried by mothers on drugs can become addicted before birth. Sources: Merck Manual of Medical Information, Journal of the American Medical Association

A CLEAN BREAKTHROUGH NEW METHADONE SUBSTITUTE MAKES THE GRADE

Written by Medication Assisted Treatment Wars