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City has its wish list

The Baltimore Sun

Baltimore Mayor Sheila Dixon is seeking $5 million in state funds to substantially expand the city's program to dispense buprenorphine, a medication used to treat heroin addiction.

The additional money would increase the number of city addicts treated with the narcotic each year from about 650 to 2,500. It doesn't include money the state's Medicaid system is spending for low-income patients in Baltimore; last year it totaled about $1 million.

"I think it's an ambitious request but it's important to set out what we think could be accomplished," said Baltimore Health Commissioner Dr. Joshua M. Sharfstein. Dixon is scheduled to announce the request at a news conference today.

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

The city's program adds a step to the federally envisioned process by filtering addicts through a network of six publicly financed clinics that dispense the pills, commonly sold under the name Suboxone, and provide group and individual counseling.

In addition to state funds, the city has spent more than $1 million over the past 14 months to treat 653 patients with the medication at six treatment centers. Some of the money has come from nonprofit groups such as the Open Society Institute. The Maryland Department of Health and Mental Hygiene allocated an additional $993,000 to the city last month to expand the program in the current fiscal year and is spending another $2 million to finance other buprenorphine programs in the state.

A three-day series in The Sun last month described how Suboxone prescribed for treatment is being sold by patients on the street, leading to growing abuse of the drug. Addicts are also injecting and snorting buprenorphine, according to health officials in several states and research from the drug's manufacturer.

Illegal sales and abuse remain far below other abused narcotics but are on the rise, especially in areas of the country where the drug is most heavily prescribed, those sources say. As state health officials in Maine reported in August: "Abuse of buprenorphine appears to be an emerging problem, most likely because the supply of buprenorphine has increased so quickly."

Sharfstein said the new money would be spent to expand the number of participating clinics and to help pay for the medication and counseling services. He said an unspecified portion would be used to minimize street sales, but he has not yet devised a plan.

"We clearly have a responsibility to explain to people what we know about diversion and how we're working to reduce it," Sharfstein said in an interview. "[The Sun's] series helped us focus on diversion. It addressed an important question that we need to constantly assess."

Sharfstein's aim has been to stabilize patients in clinics - by getting them off all illicit drugs and securing them insurance coverage - before transferring them to private doctors. Of the 653 patients, 122 have transferred to private doctors, according to city statistics from last year. But the percentage of patients staying in treatment for at least 90 days has been 65 percent, better than 90-day retention rates for other treatment methods, Sharfstein said.

The program has faced two main challenges so far: Many patients are continuing to abuse cocaine, and obtaining insurance has taken longer than anticipated.

In the fiscal year that ended June 30, three state Medicaid programs paid $1.9 million to cover the medication for low-income patients throughout Maryland. Of that, $1.02 million, or 53 percent, was spent to cover pills for patients in Baltimore, according to the state Department of Health and Mental Hygiene.



To read more, visit the General Assembly blog at baltimoresun.com/news/politics/assembly/

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