A substitute for methadone could dramatically change how addicts get clean. For a heroin addict on the long, hard road toward recovery, there’s generally one available outside aid: Methadone, a substitute for heroin and other opiates, which has been in use for more than 30 years.


But methadone presents its own challenges. You can’t just walk into a CVS and fill a prescription for it, for one thing. Instead, you have to wait in line, every day, at one of the few local clinics licensed to dispense the drug, such as Spectrum Health Systems on Lincoln Street.


Those familiar with drug detoxification say methadone programs aren’t always user-friendly. They require an allotment of time that demands serious commitment before treatment even begins. A daily trip to get medication can be time-consuming and disruptive — maybe too disruptive to leave room for a recovering addict to recover his or her normal life, particularly if that normal life involves a job with regular 9-to-5 hours.


All of that could soon change. A growing number of Worcester doctors have begun providing the drug buprenorphine, rather than methadone, to patients trying to kick heroin or other opiate-based drugs such as Oxycontin.


Methadone is injected. Buprenorphine is taken orally, under the tongue. Doctors can prescribe it like any other medication and patients can take it at their convenience. That means no more daily trips to the methadone clinic and less of the stigma associated with such treatment.


Buprenorphine can be used either for straight detoxification purposes, to help someone quit drugs entirely; or like methadone, as a maintenance therapy, in which a patient continues to take the drug as a stand-in for the illicit substance, but without the extreme high and without the drastic symptoms of withdrawal.


The federal government is limiting distribution of the drug for now (it was approved in 2002.) Any doctor or member of a group practice must take a required training course, and even then, an individual doctor or group practice may prescribe it to only 30 patients. Doctors who use the drug now predict that those regulations will be somewhat relaxed in the coming year.


A list maintained by the federal Substance Abuse and Mental Health Services Administration shows that eight Worcester doctors are certified to provide buprenorphine. One of them is Dr. Robert Pike, medical director of AdCare Hospital in Worcester, one of the region’s largest detoxification centers. He says that demand for buprenorphine is already huge. “Most of the docs I talk to are full already,” he says. “It’s incredible .... Most of the gentlemen I talk to like the drug, most of the patients like the drug and they like the detox.”


But Pike says the drug’s high cost could be a barrier to more widespread use. “Unless the insurance companies pick it up, it is going to be out of reach for a lot of people,” he says. “You are talking $3 to $5 a pill. I give them 16 milligrams [a day]. That’s four pills. That’s $12 a day times 30 [days in a month.] It’s incredible.” In comparison, methadone costs just 35 cents a day, he says.


While buprenorphine’s long-term effectiveness is yet untested, there’s little question that there need to be options to methadone as a treatment. According to some federal statistics, more than 800,000 people in the United States use heroin and millions are hooked on other opiate-based drugs; but only about 200,000 people are being treated at methadone clinics.


Another Worcester doctor licensed to prescribe buprenorphine, Dr. Jeffrey Baxter, says the local situation reflects those stark national statistics. Baxter describes Worcester as a “hot spot for heroin,” although he stresses that it’s hardly the only one. Still, he says, “For a small city, Worcester has a large heroin problem.” Moreover, there are more users coming to Worcester these days for treatment because many other detox facilities — including ones in Leominster and Framingham — have been closed due to state budget cuts, he explains: “We get all those people.”


Baxter, who practices at the Family Health Center of Worcester on Queen Street, says his group practice has 12 patients successfully using the drug, which it started prescribing about three months ago.


Baxter says that many doctors are simply afraid to try the drug out. “I’ve been going to group practices and people are saying we don’t want more [drug users visiting] our practices,” he says. “I say to them, these folks [who could benefit from] this medicine are going to be showing up in your practices anyway.” He says medical students receive little training in drug treatment, and thus haven’t developed the skills needed to feel comfortable administering such care.


Baxter describes opiate addiction as a disease, comparing it to diabetes. “[With diabetes] there’s something missing [in a patient’s body chemistry] and you replace it [with insulin],” he says. “Same thing with [opiate addiction]. There’s just something missing.”


Baxter says that having weighed “decades” of statistical evidence, he’s come to believe in maintenance therapy over straight detox programs. “My bias is to go with what works,” he says. “And maintenance is what works.”


While doctors like Baxter appear bullish about buprenorphine’s potential, there are differing opinions. In a May 6 article, Dr. Ron Brady, medical director of a methadone program in New York City, told New York Newsday that he wants to “see that it works before I start using it. I have learned that some patients should never be alone when taking their medicine.”


Others have cautioned that the drug, while promising, shouldn’t be viewed as a silver bullet. In a Sept. 2003 letter to The Boston Globe, Northampton resident Tobe Reichlin wrote of a friend’s overdose on heroin after beginning buprenorphine therapy. “Yes, buprenorphine is a miracle drug,” he wrote. “[But] a person in recovery desperately needs intensive professional counseling. Dropping a recovering addict back into life without the support systems necessary is asking for tragic, needless deaths.”