Don, a 45-year-old married father of three, broke his five-year addiction to painkillers and has been clean and sober since the day he started taking a medication called buprenorphine.

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But his success could be delaying another addict from kicking a drug habit.

That's because federal requirements prohibit a doctor from treating more than 30 patients with buprenorphine at a time. And some patients, like Don, stay on a low dose of the medication for extended periods because they don't want to relapse and use illegal drugs again, said Mariann Mellinger, a nurse at Priority Health Care Inc., Downtown, where Don goes for treatment.

"We never put somebody else on the program until somebody successfully walks off and says they don't need to come back," she explained. If the 30-patient limit were lifted, "there'd be spots open. There is nowhere for somebody to go."

Pat Valentine, deputy director of Allegheny County's Office of Behavioral Health, said the cap has prevented the development of "buprenorphine mills," offices where "a physician just sees buprenorphine patients all day."

Still, the requirement has limited access in some cases, she said.

A proposal by U.S. Sen. Arlen Specter, R-Pa., would allow physicians, with some exceptions, to serve more patients. The provision is in an amendment to an Office of National Drug Control Policy reauthorization bill.

Currently, more than 500 doctors in Pennsylvania are authorized to administer the drug, said Leah Young, a spokeswoman for the federal Substance Abuse and Mental Health Services Administration. To do so, they completed eight hours of training.

Suboxone, a combination of buprenorphine and naloxone that is used primarily for maintenance therapy, and Subutex, which is buprenorphine alone, were approved in 2002 as the first prescription medications for the treatment of addiction to opioids, such as heroin. Both preparations are made by Reckitt Benckiser.

They work by binding to the same brain receptors that heroin would, preventing withdrawal symptoms. Suboxone is not likely to be abused because of its naloxone, or Narcan, component, which will cause withdrawal symptoms if the medicine is crushed and snorted or dissolved and injected.

Suboxone "really does work," Don said. "I'd advise anybody if they were addicted to try it."

He got hooked on painkillers, including OxyContin, after they were prescribed to treat his chronic back pain. He was soon using more drugs and going to the street to buy them. But he continued to work and kept his habit a secret from his wife until he told her last month.

Don decided to quit a year ago because he got tired of being sick all the time.

"I was jumping out of my skin," he said. "You get sick and achy and sore."

The medication has been a "great new tool" to help people using heroin or other opiates, particularly those who have not been addicted for longer periods, said Dr. Michael Flaherty, executive director of the Pittsburgh-based Institute for Research, Education and Training in Addictions. Those with long-term addiction are often better treated by methadone, he said.

But Suboxone and methadone treatment are not always readily available, Dr. Flaherty said. For every person treated with those drugs, "at least another three people aren't in treatment and need it."

Some don't want it, he said. But for those who do, services have not kept pace with demand.

In Allegheny County, people on medical assistance have had less trouble obtaining treatment than those who lack coverage, Ms. Valentine said. But she noted that some people who seek treatment end up on waiting lists, despite efforts to increase services.

Cheryl Williams, director of the drug and alcohol licensing program at the state Department of Health, said that for years, Pennsylvania had about 32 methadone programs.

"Then we had a resurgence in heroin," she said, noting that methadone centers are now at capacity even though six to eight more centers have opened in the past few years. Statewide, the centers serve more than 13,000 people.

At Gateway Rehabilitation Center, the "demand for treating people with heroin addiction has never been higher," said medical director Dr. Neil Capretto. But, he added, only a fraction of people who could benefit are in treatment.

Sometimes people lose their motivation for treatment if they face the prospect of a waiting list, he said. In other cases, insurance coverage does not last long enough for the treatment patients need.

Some patients have trouble finding a doctor who can prescribe buprenorphine.

"I get calls every day from people who'd like to get it but can't find a doctor," Dr. Capretto said. "Demand for it is very strong."

Because of the cap, he typically uses the drug only for patients in detoxification, where turnover is greater. While that approach has helped patients stick with detox, more could benefit by using the drug for longer-term therapy.

Dr. Capretto added that those who have been addicted for short periods are most likely to kick the habit without needing methadone or buprenorphine.

In Western Pennsylvania, health plans offered by Highmark Inc. generally provide coverage for detoxification -- the process of purging the body of an addictive substance -- along with 30 days of residential treatment per year and 20 to 30 days of outpatient care, said spokesman Michael Weinstein. Treatment with buprenorphine is generally covered.

Yet some patients choose to pay out-of-pocket for the drug treatment because of concerns that their insurance premiums will go up or because they don't want anyone to know about their problem.

"Addiction really suffers from a terrible stigma," said Timothy Lepak, president of the National Alliance of Advocates for Buprenorphine Treatment, or NAABT. "It's not being treated as a disease. Even though people start with drugs voluntarily, it soon becomes involuntary."

In an effort to improve access to treatment, the NAABT is developing a Web-based confidential clearinghouse to match patients with local doctors who are certified to prescribe buprenorphine. A pilot project was launched two weeks ago in Pittsburgh, Baltimore, Atlanta and Farmington, Conn., where the NAABT is based, Mr. Lepak said.

Some addiction patients are sharing their medication with friends or relatives because they can't find a treatment slot, Mr. Lepak said.

There are also rumors that Suboxone is being sold on the street.

To help meet the demand, more physicians should get the eight-hour training needed to prescribe the drug, said Dr. Bhavank Doshi, an internist who works at Priority Health. But there's more to treatment than simply writing a prescription.

Counseling is a critical component of addiction treatment programs, said Dr. Antoine Douaihy, medical director of addiction medicine services at Western Psychiatric Institute and Clinic, and treatment for other psychiatric illnesses is often needed.

While some patients might recover with Suboxone or detox programs, others might do better with methadone treatment.

Methadone, Dr. Douaihy said, is "for a subset of patients who have struggled for so many years and have not been able to stay away from the street, and they keep using despite multiple interventions."

Kim, a 47-year-old married woman who lives south of Pittsburgh, credits methadone with keeping her heroin-free since 2003.

"I decided I needed to start taking methadone to keep me off the streets," she said. "It's a very humane way to get people back on their feet."

She abused drugs and alcohol in college, but quit on her own. But 15 years ago, she took painkillers after an operation. It was the beginning of the end, Kim said.

In 1999, a friend suggested she try heroin, but she feared injecting it.

"When I found out you could snort it, that's all she wrote," she said.

Her life centered on using drugs and finding money to pay for them. She made several attempts to quit using through detox and rehab before she entered methadone treatment.

Kim said that if she were still using, she probably would try the dangerous combination of fentanyl and heroin now on Pittsburgh streets.

Heroin use is "still going gangbusters," Ms. Valentine said. But death rates in Allegheny County from heroin-related overdoses have dropped in recent years.

She suggested the decline may be linked in part to education efforts, including an overdose prevention project by Prevention Point Pittsburgh that targets jail inmates.

"I'd like to say it's due to a decrease in demand. But I can't," Ms. Valentine said.

Kim has been praying for people who haven't yet overcome their addictions and are in danger of being tempted to use, with perhaps fatal consequences.

"It's a scary, sad thing," she said. "It's like you're stuck in a cage and you can't get out."