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Recovery in the News
Baltimore has new way to treat addicts; Methadone alternative has no high
Donna Leinwand
USA Today
October 5, 2006
Baltimore officials are launching a plan they hope will change the way thousands of heroin addicts in the city are treated and free up space in local treatment programs for other addicts.
The city's public health commissioner, Joshua Sharfstein, said Wednesday the idea is to shift addicts from drug treatment into regular primary care facilities by training doctors to prescribe the anti-addiction drug buprenorphine.
If the plan works, it could inspire similar programs elsewhere and dramatically change the lives of heroin addicts who now go to methadone clinics every day or every other day for a dose of the medicine, Sharfstein says. Methadone blocks addicts' cravings for heroin and their withdrawal symptoms, but it also can be addictive and abused easily, so it must be dispensed in small doses at special clinics.
Buprenorphine -- a prescription drug used to treat addictions to heroin and other opioids such as the prescription drug OxyContin -- also blocks cravings and withdrawal symptoms without making the user high. Buprenorphine is difficult to abuse, so patients can get a 30-day supply from any primary care physician trained to prescribe it.
Baltimore's plan is being watched by drug specialists nationwide because the city, long plagued by rampant drug use, has become something of a laboratory for various experiments aimed at getting addicts into treatment and cracking down on drug dealing.
Nationwide, about 1.5% of people 12 or older have used heroin in their lifetime, according to the 2005 National Survey on Drug Use and Health, the most comprehensive government assessment of the nation's drug use. Marijuana is far more popular: 46% of those 12 or older reported some use.
In Baltimore, however, heroin has been among the most abused drugs for years, Sharfstein says. In 2003, 71% of the 24,700 Baltimore residents who sought drug treatment said they had abused heroin.
Sharfstein said the city has allocated $250,000 to train primary care doctors how to prescribe buprenorphine. Eventually, the city hopes to treat 10,000 of the city's estimated 40,000 heroin addicts through the program.
"I'll be the first to say this is a somewhat risky endeavor," Sharfstein said in an interview. "We're really trying to engage the medical community in something they haven't done before."
Baltimore can treat about 23,000 uninsured people a year for drug addictions, Sharfstein says. Moving 10,000 recovering addicts to buprenorphine treatment with primary care doctors after they have been stabilized by drug treatment specialists would clear space in traditional treatment programs for more patients, he says.
All doctors practicing in the Baltimore Medical System, a group of private, non-profit community health centers, will receive the training, says Kyu Rhee, the group's chief medical officer. BMS sees 41,000 patients a year at 12 primary care clinics in the area.
Historically, addicts receive intensive treatment in specialty clinics but may not receive follow-up care, says Rhee, who supports Baltimore's plan. By shifting addicts to primary care doctors, the addicts' overall health can be managed along with their recovery, he says.
Gov. Robert Ehrlich, a Republican, has criticized Baltimore Mayor Martin O'Malley for his police department's aggressive neighborhood policing. O'Malley, Ehrlich's Democratic opponent in the election Nov. 7, has said his community policing program is intended to clean up open-air drug markets and improve quality of life.
About 7,500 of the half-million ambulatory care doctors nationwide are trained to prescribe buprenorphine, says Daniel Alford, medical director of the opioid treatment program at Boston Medical Center. "If there's a big push from a state or a city, it will help ease the barrier for doctors and will improve access for patients," he said.
© Copyright 2006 USA TODAY, a division of Gannett Co. Inc.