Pubdate: Thu, 19 Jul 2007
Source: Baltimore Sun (MD)
Copyright: 2007 The Baltimore Sun, a Times Mirror Newspaper.
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: Doug Donovan
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

PROGRAM FOR HEROIN ADDICTS IS LAUDED

Sharfstein Says Progress Made On Bupe Treatment, But Hurdles Still Remain

Baltimore health officials are heralding early successes in their 
effort to combat heroin addiction with a new drug, but say that the 
novel program faces several obstacles to better achieve its objectives.

The city's health commissioner, Dr. Joshua M. Sharfstein, unveiled 
yesterday his agency's progress report on the Baltimore Buprenorphine 
Initiative, which has spent more than $900,000 since October to 
shepherd heroin addicts into drug treatment, find them health 
insurance and match them with personal physicians.

Congress approved buprenorphine five years ago for treating opiate 
addiction. Patients obtain prescriptions from primary care doctors 
and take their medicine in the privacy of their homes. It is a major 
shift from heroin's traditional treatment with methadone, which 
requires most patients to line up at public clinics for their daily doses.

Related Links  PDF: Buprenophrine Interim Report      Sun coverage: 
An alternative to methadone      Dr. Joshua M. Sharfstein 
Photo   "The way Baltimore has packaged this and presented this and 
put it into operation, I would consider it to be a model that other 
people ought to take a look at," said Dr. Peter Cohen, medical 
director of the state's Alcohol and Drug Abuse Administration.

Outside the city, Baltimore and Howard counties are the only 
jurisdictions in Maryland with programs of their own, but more are 
expected since the state recently approved $3 million for statewide 
buprenorphine efforts, Cohen said.

At a hearing before the City Council's housing, health and human 
services subcommittee last evening, Sharfstein noted several 
successes of the initiative.

One of the most critical findings is that of the 269 addicts who 
entered the program before April 1, 65 percent have remained in drug 
treatment for at least 90 days in one of the six treatment centers 
participating in the initiative. That nearly meets "the initial 
benchmark of 67 percent retention at 90 days," the report states.

That's a "decent" result, Dr. Peter L. Beilenson, Howard County's 
health commissioner and Sharfstein's predecessor, said in an interview.

"But I would have hoped that would have been higher," Beilenson said. 
"I would argue that the typical bupe patient should be at least as 
successful as the typical methadone patient."

He said methadone treatment centers typically see 90-day retention 
rates of 80 percent to 90 percent.

The report also described how the initiative has taken advantage of a 
year-old health insurance plan for individuals living in poverty but 
who are not eligible for Medicaid and Medicare.

With the help of Baltimore Substance Abuse Systems Inc. and Baltimore 
Healthcare Access Inc., addicts have been steered into the state's 
Primary Adult Care program, which provides limited outpatient care 
that covers buprenorphine's cost.

The report states that at least 65 percent of 251 current patients in 
the program were signed up for the PAC program and that an additional 
14 percent are set for approval.

Getting insurance for patients, putting them through initial drug 
treatment for three months and paying for urine tests to check their 
compliance make the entire program more palatable to doctors, Sharfstein said.

"The medical system has to do something different, which is be able 
to see patients for a disease that they typically pushed over to the 
mental health or substance abuse system," Sharfstein said. "It's 
really a shift in how you think about how drug treatment happens and 
is financed."

The shift began in 2002 when Congress first allowed doctors to 
prescribe buprenorphine if they took an eight-hour course to obtain a 
government waiver to administer the drug, which is a synthetic 
opiate. Doctors at first were allowed to treat only 30 patients, but 
that was changed last year to 100 for doctors with one year of 
experience. It is a sharp departure from traditional methadone 
treatment, which is heavily regulated inside clinics.

Buprenorphine's advocates say it is more effective than methadone 
because its most commonly used form, Suboxone, is combined with an 
agent that makes it less prone to abuse and overdose. Methadone is 
still recommended for addicts who require high doses of heroin.

The challenge for public health officials like Sharfstein has been 
finding doctors willing to take the eight-hour training.

"I won't remain satisfied if we don't see significant increases in 
doctors," Sharfstein told Council President Stephanie Rawlings-Blake yesterday.

As of June 30, 93 physicians had signed up for training, which is 
paid for by the city, and 50 had completed it. Of those, 39 have 
received their federal waiver. The initial goal was 100 physicians to 
have completed training by Dec. 31, 2006.

The program had also hoped to see more patients transferring out of 
treatment into the care of doctors at approximately 90 days. As of 
June 30, 62 patients had transferred after an average time of 155 
days in treatment.

The main problem was a delay in getting PAC insurance, but the city 
has now been given authority by the state to register patients for 
the coverage. Other patients did not transfer due to other 
addictions, especially to cocaine, Sharfstein said.

One former addict, Valarie Clark, who called buprenorphine a "wonder 
drug," told the council that her treatment had been a success.

The 51-year-old West Baltimore grandmother said she has been a heroin 
and cocaine addict for nearly 20 years and that last year she had "no hope."

"I can now say I love life," she said. "All because of the drug 
called buprenorphine."
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MAP posted-by: Beth Wehrman