Maryland health officials told state lawmakers yesterday that they were taking steps to minimize possible abuse of the addiction treatment buprenorphine as they spend millions to expand its availability.
While insisting that misuse is currently not a serious problem, they outlined precautions in an appearance before a House of Delegates committee. These include screening for buprenorphine in overdose deaths, coordinating with police to monitor street sales and supporting a bill that would call for monitoring prescription drugs, including buprenorphine.
"The benefits of treating opioid addiction are enormous," John M. Colmers, secretary of the state Department of Health and Mental Hygiene, told the Health and Government Operations Committee. "There are still risks associated with buprenorphine, but they have to be weighed and measured against the benefits. In all three of those areas, we look forward to making progress."
The hearing came on the day that the Baltimore City Health Department released a report on overdose deaths going back 12 years. It confirmed the first known death in Maryland associated partly with buprenorphine, and noted that deaths in the city linked to heroin have fallen while those involving the heroin substitute methadone have surged.
A 40-year-old woman died in Baltimore on May 11, 2007, from "narcotic intoxication (methadone and buprenorphine) and cocaine use," according to medical examiner's office records.
The medical examiner's office declined yesterday to release the woman's name or provide other details of her death.
Methadone was linked to 60 deaths between January and September last year. Heroin was present in 137 fatal cases during that time, though officials said they could not determine the precise role either drug played in causing deaths.
A three-day series in The Sun last month described how buprenorphine, prescribed as Suboxone for addiction treatment, is being sold by patients on the street. Addicts also are injecting and snorting the narcotic, according to health officials in several states and research from the drug's manufacturer.
Several health officials -- including the married couple of Dr. Joshua M. Sharfstein, Baltimore's health commissioner, and Dr. Yngvild Olsen, Harford County's deputy medical officer -- told officials that addicts using the drug on the street mostly say they do so to avoid withdrawal, not to get high.
"That is not the type of diversion that is a public health crisis," Sharfstein said. "It doesn't mean I support it."
Sharfstein told the committee that The Sun's series did not adequately address buprenorphine's benefits and did not credit the city's program for the measures it has taken to prevent misuse.
"I'm not happy about any diversion," he said. "There's a big difference between a pill being sold on the street that's used by people to avoid withdrawal ... and a pill that is injected and used for euphoria."
An addict named Charlene who accompanied Sharfstein credited the drug with saving her life, calling it her miracle pill. She also said she first tried it on the street, as others have, to avoid the painful withdrawal symptoms that set in when addicts cannot get heroin.
In parts of the country where buprenorphine is most readily available, such as Maine, Vermont and Massachusetts, people have misused it, and several have died after mixing it with other substances, The Sun reported.
Del. Eric M. Bromwell, a Baltimore County Democrat, elicited laughter by criticizing The Sun's reporting of buprenorphine being in the deadly mix rather than blaming the other substances.
Sharfstein also had complained that The Sun's series overstated the drug's danger, but he quickly acknowledged that "if we're not serious about the risks" of buprenorphine abuse, that could jeopardize the treatment's benefits.
Sharfstein said the city has taken 14 precautions to prevent illegal use, including pill counts, tests for buprenorphine's presence in patients' urine and asking them if they have used the drug on the street.
But his initiative, which is costing $3 million and has treated nearly 700 people, does not systematically track how many patients have tried it on the street first and how many clients have failed urine tests to determine whether they are taking the drug.
Sharfstein said after the hearing that the six treatment centers in his initiative all have different standards for how to handle patients when they fail pill counts or if their urine screens show they are not taking their pills.
Dr. Peter Luongo, director of the state Alcohol and Drug Abuse Administration, told lawmakers that buprenorphine testing is "a key and crucial element" that the state plans to require. He also said results would be tracked through its computer system.
Sharfstein said Maryland does not have that tracking capacity, but that he believes it should. He also supports screening for buprenorphine in overdose deaths.
Dr. David R. Fowler, the state's chief medical examiner, said that routinely testing for buprenorphine through blood tests would be too expensive, costing upward of $1 million a year. Start-up costs alone could be $500,000, he said. Instead, Fowler said he would prefer less expensive urine screens to detect its presence before ordering blood tests.
A committee that governs the medical examiner's office is expected to review the issue, Colmers said.
The city has spent more than $1 million on its 15-month-old buprenorphine program and wants an additional $5 million from the state. The state has spent about $5 million to support Baltimore, start programs elsewhere in Maryland and cover the Medicaid costs of Suboxone. And it is set to spend another $1.6 million, Luongo said.
Del. Shawn Z. Tarrant, a Baltimore Democrat, said that even if the drug is being sold on the street, it is not wreaking the havoc that heroin use causes such as robberies and prostitution.
"People will abuse anything," Tarrant said.
Sun reporter Fred Schulte contributed to this article.
Read the full report on overdose deaths at baltimoresun.com/overdose