U.S. BILL TARGETS 'BUPE' LIMIT

It Aims To Expand Aid For Heroin Users

Bill Aims To Expand Aid For Addicts

The number of heroin addicts receiving a revolutionary drug that is
safer than methadone could triple under pending federal legislation
-- a change that Baltimore health care advocates say could help the
city combat addiction.

Physicians would be allowed to prescribe buprenorphine, commonly
known as "bupe," to 100 patients -- up from the current 30-patient
limit. Unlike methadone, bupe is taken at home and is less prone to abuse.

Related Links Sun coverage: An alternative to methadone Easing
buprenorphine regulations will boost an initiative crafted this year
by City Hall to train more doctors to prescribe the drug. The effort
could speed distribution of buprenorphine in a city long considered
one of the most addicted in the nation.

"Whatever we're able to accomplish with our effort, this potentially
triples the impact," said the city's health commissioner, Dr. Joshua
Sharfstein.

About 1,000 people in Baltimore take buprenorphine, compared with
about 4,500 who receive methadone every day, according to city estimates.

The Food and Drug Administration approved buprenorphine for opiate
addiction in 2002 but regulated its distribution to discourage
misuse. Congress requires doctors to receive eight hours of training
and limits the number of patients they are permitted to treat with the drug.

The new legislation, part of the Office of National Drug Control
Policy Reauthorization Act of 2006, was approved by Congress on Dec.
8. A White House spokeswoman said President Bush is reviewing the legislation.

"This gives us an opportunity to treat more people and to get them on
their way to living a life where they are no longer addicted to
heroin," said Rep. Elijah E. Cummings, who supported the bill. "All
of this is an effort to heal our city."

One advantage of buprenorphine is that patients can be treated by a
primary-care doctor rather than at a methadone clinic. The approach
gives addicts who might not receive regular medical attention more
frequent contact with a physician.

As part of the city's effort, drug treatment centers are getting
addicts clean with buprenorphine and then referring them to family doctors.

"You can see the ravages that drug addiction has created in the
city," said Adam B. Brickner, president and chief executive officer
of Baltimore Substance Abuse Systems Inc., a nonprofit organization
that oversees publicly funded drug treatment programs. "There's a lot
of stigma around addiction still. Hopefully, we're slowly going to
erode those and people will recognize that this is a medical condition."

In October, Sharfstein announced that Baltimore would train at least
100 more doctors to prescribe the drug. More than 40 doctors signed
up for the training, but area hospitals have committed to send
hundreds more through the program.

Howard County used private money to coordinate training last year,
but only seven physicians signed up. National experts have said it is
unusual for local governments to pick up the cost of training, and
Baltimore's program appears to be considerably more ambitious than
what has been attempted elsewhere.

Few, if any, primary care doctors will immediately pick up 100
patients. But Dr. Michael Fingerhood, an internist at Johns Hopkins
Bayview Medical Center, said the higher cap allows doctors to treat
more stable patients while taking on new ones.

Fingerhood has prescribed buprenorphine for three years along with
four other doctors in his office. At least two are nearing the
30-patient limit.

"It certainly takes a lot of time and effort to do this right and I
think we all want to make sure that we do this right," Fingerhood
said. "But 30 was limiting."