By John Bobo, Director, National Traffic Law Center, American Prosecutors Research Institute, Alexandria, Virginia

The Drug Addiction Treatment Act of 2000 expands the clinical context of medication-assisted opioid addiction treatment by allowing qualified physicians to dispense or prescribe specifically approved schedule 3, 4, and 5 narcotic medications for treatment of opioid addiction in settings other than the traditional methadone clinics. In October 2002, the U.S. Food and Drug Administration's approved doctors to prescribe buprenorphine for the treatment of drug addiction. The use of this drug raises concerns about impaired driving.

Drug More Potent Than Methadone
For the first time outside a methadone clinic, doctors will be able to prescribe a narcotic drug for the treatment of opiate dependence. What attracted the treatment community is that buprenorphine induces far less respiratory depression than methadone and is thought to be safer in an overdose situation. Yet the drug is potent. The Drug Enforcement Administration (DEA) describes buprenorphine as having 30 to 50 times the analgesic potency of morphine. Ultimately, what that means on the highways is that persons could use this drug and then drive while impaired. Law enforcement officers and prosecutors need to be aware of the drug and the challenges involved in identifying the impaired drivers.

Until now, opiate dependence was treated by a limited number of methadone clinics specializing in addiction treatment. Methadone treatment became popular about 30 years ago and has remained controversial. Typically, most methadone clinics dispense a single day's dose of methadone, requiring addicts to show up for treatment every day. The Food and Drug Administration's (FDA) new ruling has been heralded by some as a means of opening up treatment to the many heroin addicts in the United States who are unable to be placed in treatment slots or unable to arrive daily at methadone clinics. Members of the medical community now believe there is a treatment option previously unavailable to many patients.

Under the Drug Addiction Treatment Act of 2000, approved physicians can prescribe buprenorphine to treat up to 30 patients. With the prescription, addicts will receive a 30-day supply of the drug and are allowed five to six months of refills. Buprenorphine will be sold under two names: Subutex for the initial stage of treatment, and Suboxone, which also includes the drug naloxone, for maintenance treatment.

Before dispensing the narcotic, physicians must undergo eight hours of training and register with the federal Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment and the DEA. Under the regulations, doctors are not allowed to provide buprenorphine for pain - only opiate addiction.

Managing the Impaired
Driving Risks
The FDA has initiated a risk management program of "active and passive surveillance" to see if the drugs are being abused. According to the FDA, "[t]he surveillance will include interviews with substance abusers, monitoring local drug markets, data collection, and the monitoring of adverse event reports." These reports will enable the FDA to "take appropriate actions to protect the public health."

Impairment Observations: In the meantime, the reality is that law enforcement officers and prosecutors will serve as the front line of protection against abuses. With access to buprenorphine, there will likely be an exponential increase in its abuse, typical of what the law enforcement community has witnessed surrounding methadone clinics. That abuse will lead to impaired driving, sale of narcotics, and other substance abuse crimes. These risks are recognized in other countries where buprenorphine was legalized for heroin dependence years ago. Australia's Department of Human Services warns that buprenorphine overdoses can present symptoms:

• Slurred speech


• Unsteady walking and poor balance


• Drowsiness


• Slowed movement


• Confusion


• Sleeping for prolonged periods

In later stages of an overdose, buprenorphine may cause a person to have floppy limbs, blue lips, and an inability to regain consciousness leading to a coma.

Testing for Methadone or Buprenorphine: Law enforcement officers and prosecutors will also need to make a special testing request to their drug toxicology laboratories. No one should assume that a screen of blood or urine for opiates would detect methadone or buprenorphine. The results of a special test for buprenorphine can help prosecutors secure a conviction and treatment for the offender, and it can allow the offender's physician and other treatment professionals to better treat and monitor the driver.

Enforcement, prosecution, and court-monitored treatment have a major role in keeping drug abuse in check on and the impaired driver off the roads. With the advent of this new heroin treatment program law enforcement and prosecutors need to prepare for the abuse and incidents of impaired driving.

For more information, visit SAMHSA's Web site at (www.buprenorphine.samhsa.gov), or visit the American Prosecutors Research Institute in the National Traffic Law Center at (www.ndaa-apri.org).

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