Pubdate: Thu, 15 Aug 2013
Source: Baltimore Sun (MD)
Copyright: 2013 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: Deborah Agus
Note: Deborah Agus is executive director of the Behavioral Health 
Leadership Institute and adjunct faculty at the Johns Hopkins 
Bloomberg School of Public Health.

BRINGING ADDICTS IN FROM THE STREETS

It is mid-morning on a recent Friday in West Baltimore, and there is 
a long line snaking down the street and around the corner. Why? 
Vendors are dispensing free heroin samples.

In other areas of the city, buyers are risking arrest and drug 
contamination to illegally purchase buprenorphine. It is legal 
medication when given with a prescription. It is used to treat opioid 
addiction and facilitate recovery. So why buy it illegally? Not to 
get high as a substitute for heroin. They are using it to treat their 
heroin addiction. These purchasers can't afford or otherwise access 
this medication legally. Their only option is to buy it on the 
streets and self-treat. These purchasers are addicts who are so 
motivated to get clean that they are taking great risks to get it.

On July 11, The Sun reported that "[h]eroin overdose deaths soared 
last year in Baltimore, a city that has struggled with one of the 
highest rates of heroin addiction in the nation and with the violence 
that comes with illegal drug dealing."

The above scenarios reflect different facets of a tragedy. Addiction 
to opioids, including heroin and prescription drugs, affects a 
diverse population in increasing numbers. The results are often fatal 
and extremely costly in both human and economic terms. Yet, addiction 
is treatable. There are highly effective medications. When these 
medications are given along with therapy to repair the ravages caused 
by long-term addiction, there is a good chance for recovery.

So why is the situation worsening instead of improving? And why do we 
allow this to happen?

Drug addiction is a disease, but the stigma of addiction continues.

Opioids are narcotics that mimic naturally produced chemicals our 
bodies need, but they have much stronger effect and are introduced 
into the brain in much greater quantities than natural hormones. 
Opioids act primarily by interacting with the central nervous system 
and result in sedation, pain reduction and sometimes euphoria. All 
opioids are highly addictive and can lead to physical dependence in 
most people.

There are a variety of treatment options available for opioid 
addiction. Some programs treat with total abstinence accompanied by 
personal support, and some addicts succeed with this approach. 
However, most patients need medication to address the chemical and 
physical damage. The two primary medications are methadone and a 
compound called buprenorphine.

Both medications are effective in promoting recovery. Methadone is 
dispensed only by special clinics and the patient has to go weekly 
and stand in line, making it inaccessible and highly stigmatizing for 
many. Buprenorphine can be dispensed like a regular prescription at a 
clinic or by a private physician who gets certified training, so it 
lends itself to integrated treatment in doctors' offices or 
integrated health care homes.

Buprenorphine is a safe and effective medication. However, as 
evidenced by the increase in overdose deaths in Baltimore, there 
remain many who have difficulty accessing treatment. The Behavioral 
Health Leadership Institute, with funding from the Open Society 
Institute-Baltimore and the Abell Foundation, offers a unique 
treatment program to reach unserved populations. A doctor and nurse 
from Johns Hopkins Bayview go into recovery centers to provide 
treatment. These centers provide peer support and are trusted by 
community members, thus improving engagement. The clinical team then 
works with peer support staff at the sites to function as a treatment team.

This program is unique for several reasons: because of the 
untraditional community settings; because it uses medical 
professionals as necessary, but sparingly; and because it is 
flexible, cost-effective and user-friendly.

The program outcomes, which include successfully engaging clients and 
transitioning them into permanent treatment, are positive. Current 
enrollees say the program is so valuable because it is so accessible. 
Developing creative, flexible and effective programs is critical to 
meeting needs of the diverse populations that fall prey to addiction. 
To stem the tide of addiction, violence and death, funding must 
support and expand an array of flexible, effective, well-researched 
programs. Then we can invite everyone in from the streets.
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MAP posted-by: Jay Bergstrom