Baltimore's health commissioner told the city's top criminal justice leaders yesterday that his agency will do more to minimize street sales of buprenorphine, an addiction treatment drug for which the city and state are spending millions of dollars.
Commissioner Dr. Joshua M. Sharfstein has said that misuse of the drug is not a public health problem, but that he will take specific action to reduce street sales - called diversion - as the city expands buprenorphine treatment.
"It's available on the street," Sharfstein told the Baltimore Criminal Justice Coordinating Council at a presentation at the downtown courthouse. "We know this is happening. We're trying to limit diversion. I'm not happy about it but I don't think it's a public health crisis."
Sharfstein provided a document to the panel that spelled out three steps on how he plans to minimize diversion: meet regularly with police about the buprenorphine and other drugs on the streets; review the manufacturer's quarterly reports monitoring misuse; and examine overdose deaths associated with alcohol and depressants such as sedatives, which can be deadly when mixed with buprenorphine.
Sharfstein has previously said that he also wants Maryland's medical examiner to routinely test for buprenorphine, commonly sold under the name Suboxone, in overdose deaths. In addition, he intends to track test results showing whether patients are taking their buprenorphine.
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 narcotic. Addicts also are 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.
"It's a very fair question to ask what we're doing to minimize the risk because buprenorphine comes with risks," Sharfstein said. "The benefits strongly outweigh the risks. If we're cavalier about the risks it could undermine support about the benefits."
His comments come a week after Mayor Sheila Dixon asked the General Assembly to allocate $5 million to increase the number of city addicts treated with the narcotic each year from about 650 to 2,500.
The city has spent more than $1 million on its 15-month-old program. The state has spent $5 million to support Baltimore's program, start others elsewhere in Maryland and to cover the Medicaid costs of Suboxone.
The House of Delegates' Health and Government Operations Committee will hold a briefing Jan. 24 on the drug that will feature presentations from Sharfstein and Dr. Peter Luongo, director of the state's Alcohol and Drug Abuse Administration.
Some lawmakers said they want to hear how the state is planning to minimize diversion of the state-financed medication.
"The drug should not have been introduced as a matter of policy without having considered those questions [about misuse]," said Del. Richard B. Weldon Jr., a Republican representing Frederick and Washington counties.
He said the state should provide basic protections when taxpayer money is being spent to deliver the drug to addicts. The existence of street sales of the drug should have led the state Department of Health and Mental Hygiene to require the medical examiner to routinely test for it in overdose deaths, he said.
"To ignore that is irresponsible on the part of the state," he said. "We have performance measurements in other places where there is no potential harm for individuals."
Del. Patrick L. McDonough, a Republican representing Baltimore and Harford counties, agreed.
"Do you need a tragedy or an audit two years later to tell us there is a problem?" McDonough said.
Del. B. Daniel Riley, a Democrat representing Cecil and Harford counties, said the state should systematically track urine tests of patients to make sure they are taking their Suboxone.
If Suboxone is not present, it is highly likely that partients are selling it, said Dr. J. Ramsay Farah, president of the Maryland Society of Addiction Medicine.
Farah said the problem in Maryland might not be as pronounced as other states where the per-capita use is higher, but that those problems will increase as the state expands its supply.
"Right now, everyone is happy because the right people are getting the drug," he said. "As more people get it, you will see more of the wrong people getting it."
The directors of four clinics in Baltimore's buprenorphine initiative told The Sun that many addicts come to them having first tried the pill on the street. Police say Suboxone's presence is becoming more noticeable.
In August, police arrested Darryl Thomas in the 1700 block of Pennsylvania Ave. for possession and distribution of Suboxone. Thomas, 42, of the 2800 block of Joseph Ave., pleaded guilty to the charges in November, according to court records.
In the six-page document he gave officials yesterday, Sharfstein reported that the drug's manufacturer, Reckitt Benckiser Pharmaceuticals Inc., found in its studies that "fewer than 10 percent" of doctors across the country reported knowledge of misuse of the drug to get high.
Yet in the company study published October, its consultants found that half of the doctors they surveyed were aware of an illegal trade in buprenorphine and that their numbers have been climbing. The study concluded that: "It was the patients in treatment for opioid abuse - no doubt selling or trading their own supply of buprenorphine - who were seen as major contributors to the street supply."
Related coverage at baltimoresun.com/bupe