By Tina Hesman Saey, St. Louis Post-Dispatch

It was 6 feet to the floor. Paula Lowry, 52, of Fairview Heights tumbled off a ladder and landed on her back in a world of hurt.

Her doctor gave her the pain reliever oxycodone, a narcotic related to morphine and heroine. He upped the dose when the pain got worse after back surgery. When her pain didn't go away, he raised it again. Ever higher the dose climbed but she got no relief.

He upped the dose when the pain got worse after back surgery. When her pain didn't go away, he raised it again. And again. But she got no relief.

Her heart was racing. She was short of breath, in constant pain, and worried.

"I felt like was just losing my mind worrying about whether I was going to be able to get this medication," Lowry said.

She had fallen off the ladder in 2001 while stocking shelves at work. Now, five years later, she was hooked on pain pills. And the doctor, realizing she was addicted, cut off her supply.

An expensive stay at a treatment center or a quick detox were out of the question. She found help in an emerging but debated treatment: another drug.

Despite volumes of scientific data showing that addiction has a firm biological basis, its treatments reflect established attitudes that addiction results from a lack of willpower or a failure of character.

But with a relapse rate of 80 percent to 90 percent, it's clear that most traditional treatments don't work for many addicts. So a still small but growing number of addiction treatment programs are adding medications to their toolboxes.

Assisted Recovery Centers of America, in St. Louis, is one of them.

The treatment center is guiding Lowry's recovery.

"There are some people who treat addictions who don't believe in treating their patients with medication," said Frank Vocci, director of the division of pharmacotherapeutics and the medical consequences of drug abuse at the National Institute on Drug Abuse.

"It's an ideological thing. They just think the issues that patients are having won't be solved by giving them another drug. It flies in the face of a lot of data."

Many doctors and counselors who treat addiction pay lip service to it as a medical condition, but treatments reflect a different attitude.

"Since the temperance movement it's been (regarded as) moral fiber disease," Vocci said.

Treatments for addictions rarely mirror those of other chronic diseases, nor match their success rates.

"We know the circuitry of most addictions in the brain, but we tell people, 'You've got to go to AA, be honest with people and find a spiritual side.' That's interesting, but we don't tell people who've had a heart attack the same thing," said Dr. Jon Grant, associate professor of psychiatry at the University of Minnesota.

crutches?

Many doctors and counselors argue that medications are crutches and shouldn't be part of treatment because they don't force patients to confront their problems and addictions.

At the Betty Ford Center, one of the most famous addiction rehabilitation programs in the United States, success rates for treating opioid addicts - people addicted to substances including heroin, prescription pain pills, opium and morphine - were discouragingly low.

Opioid addicts walked out before completing treatment at twice the rate of alcoholics, said John Schwarzlose, president and chief executive of Betty Ford.

Then the center joined a clinical trial for a medication called buprenorphine, the drug that helped Lowry. The medication works by blocking access to receptors on brain cells that trigger euphoria. It relieves withdrawal symptoms but doesn't give people a high.

"All of a sudden, opioid addicts were staying in treatment," Schwarzlose said.

With their worst withdrawal symptoms relieved, the addicts felt well enough to continue treatment. The Ford center now uses the drug regularly for detoxing people addicted to narcotics, but the center doesn't continue patients on the medication once they have gotten past the withdrawal stage.

Nor does the center use naltrexone or other drugs to treat alcoholism in its regular inpatient program. Alcoholics who have frequent relapses may get the drugs to help them resist cravings, but the center doesn't use the medications as a first resort, Schwarzlose said.

"Building a life is more than just getting clean and sober," he said. Addiction is a biological, psychological, social and spiritual disease, Schwarzlose said. "We don't believe that if you give a shot that takes away 30 days of craving that you'll deal with all those other issues."

chance to heal

Chrys Parmentar, 46, of St. Louis, disagrees. The daughter of two alcoholics, Parmentar could pour a perfect Manhattan by the time she was 7.

She started drinking at 15 and crossed the line into alcoholism soon after. She tried inpatient rehab. She tried Alcoholics Anonymous. Still she drank, consuming half a gallon of vodka every two days.

The injectable form of naltrexone is helping her overcome more than three decades of alcoholism, Parmentar said. Each month, she goes to the Assisted Recovery Center's office for an injection of a long-acting form of naltrexone. The shot helps with her craving for vodka.

"Now that I don't have to deal with the physical part, I can start healing mentally," Parmentar said. She attends group meetings at the center two to three times a week, and her husband, Bob, goes to a weekly meeting for family members of patients.

Such counseling sessions are key to recovery, said Dr. David Ohlms, the medical director of the chemical dependency program at CenterPointe Hospital in Weldon Spring.

"None of these drugs are a major breakthrough, in my opinion," Ohlms said. But, coupled with counseling, the medications can be useful tools for helping some alcoholics and addicts stay sober.

When naltrexone was first approved more than a decade ago, Ohlms tried it for his alcoholic patients.

"I was pretty quickly disillusioned," he said. The drug has many side effects, including nausea and vomiting, and can damage the liver, something people who drink heavily can ill afford.

About three years ago, the Food and Drug Administration approved a new drug, called acamprosate, for dampening alcohol craving.

Ohlms was skeptical, but he saw a high number of his patients experience drastically decreased cravings while on the medication. It also didn't have the severe side effects of the earlier drug.

ignorance, fear

Many doctors aren't even aware that the medications exist. Others don't want to alienate their patients by bringing up substance abuse problems.

But mostly, doctors would rather not identify alcoholism or addiction in their patients because they don't know to treat it and don't want to deal with it, Ohlms said.

Ohlms and other addiction medicine specialists are trying to train other doctors, particularly psychiatrists, about the new medications. So far, the response has been tepid. At a recent workshop, only 14 of the 360 attendees were physicians, he said.

The Substance Abuse and Mental Health Service Administration lists only 25 doctors in the metro area who are authorized to prescribe buprenorphine.

A new website called Live Outside the Bottle has 14 St. Louis-area doctors listed in its alcoholism treatment database as physicians who prescribe medications to aid recovery. The database is incomplete, so other doctors may also treat alcoholic patients with medications.

Part of the blame for the skepticism lies with those who tout addiction medications, said Percy Menzies, a pharmacist and director of the Assisted Recovery Centers of America.

Beer was once considered a remedy for vodka and wine addiction, and morphine, LSD and Valium were used to treat alcoholism before people knew the drugs were addictive.

"People say, 'We do not trust science because every time we put our trust in you, you let us down,'" Menzies said.

Menzies insists the new drugs are different. Naltrexone and acamprosate used to treat alcoholism are nonaddictive.

Buprenorphine can be used to get high, but to prevent abuse, it is usually laced with another drug that will send a user into withdrawal if the pills are pulverized and snorted or injected. Its use is highly regulated by the federal government.

Paula Lowry wants everyone with a prescription drug problem to know the medications are available.

She's been in treatment with buprenorphine for seven months. As her dependence on narcotic pain relievers lessened, so did her pain.

Lowry is now able to exercise and spend time with her granddaughter.

"I was so dead inside," she said. "I just didn't have any feelings at all. Now it's all coming back and I feel like myself again."

Source: St. Louis Post-Dispatch 06/03/2007
Includes RELATED SLIDE SHOW: Patients get help for addiction