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."