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Expanding treatment

The Baltimore Sun

As part of their financial "wish list" from the state, Baltimore officials are seeking $15 million to expand drug treatment, including $5 million that would be used to provide more buprenorphine, the synthetic opiate that has proved to be an effective antidote against heroin addiction. There are legitimate concerns - including those raised in a recent series in The Sun - about "bupe" being sold illegally as a street drug. City officials are aware of the concerns and have added important safeguards. But the city's extensive drug problem justifies the request.

City officials estimate that there are only enough treatment slots to satisfy about one-half of potential demand, and they would use about $10 million to expand other substance abuse remedies, such as residential treatment programs. The rest would be focused on bupe.

In the next year, the population of addicts using bupe could be increased from about 350 to 1,000 a day. That would still be well below the more than 3,800 people who are given methadone each day. But it would greatly accelerate a treatment that can be administered under a doctor's care more privately than methadone, making it potentially more acceptable to addicts trying to kick the habit.

Under the city's current bupe program, about 30 percent to 40 percent of spending is for the medication; the rest covers such additional components as physician hours, counseling and case management. Careful screening and evaluation of bupe patients as well as behavioral therapy are among the safeguards already in place to help ensure that those receiving the medication have the best possible chance for a sustained recovery. Those safeguards can also help prevent diversion of the drug for street use and other illegal purposes. In addition, the city's Health Department plans to step up its monitoring efforts and increase coordination with law enforcement.

Beyond the city's watchful eyes, a new federal initiative to keep track of addict deaths involving bupe or methadone is another welcome and important way to help prevent abuses.

Given the size of the city's drug problem, even if the wish list is granted (which may be unlikely in these tight fiscal times), the city still won't have treatment on demand. But the closer Baltimore can get to that goal, the better.

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