'Bupe' seizures rise as treatment use grows

The Baltimore Sun

Police seizures of buprenorphine increased rapidly in Baltimore City and County in 2007, the same year that local and state government began spending millions to expand use of the narcotic to treat opiate addicts, police drug lab data show.

The numbers provide evidence of growing illegal sales and abuse of buprenorphine, a trend seen nationally.

This month in Wise County, Va., authorities arrested seven people suspected of dealing buprenorphine, which is sold mainly as Suboxone.

"I think [buprenorphine is] the fad; it's the latest thing on the block," said Dr. J. Ramsay Farah, past president of the Maryland Society of Addiction Medicine. "People who are on drugs like to experiment with new things."

Doctors prescribe Suboxone to help ease addicts' withdrawal symptoms and mute their cravings for heroin and opiate-based pain pills such as OxyContin. But some people can get high on the drug, especially if they crush the pills and inject or snort them. A series published by The Sun in December disclosed how the growth of Suboxone prescribing has fueled illegal sales, mainly because some patients are selling pills.

Even though the trade in Suboxone is a fraction of the market for heroin and cocaine, police are noticing. A Baltimore Police Department document distributed to officers last month noted Suboxone's abuse potential and stated that the pills are widely available for $5 to $10.

Officers submit substances they seize in arrests to their drug labs. Lab data provide an important indicator of which pharmaceuticals are being sold illegally.

For the first time since Suboxone was introduced in 2003, city and county police labs examined more buprenorphine cases last year than methadone, an older and far more abundant opiate treatment medicine.

In 2007, Baltimore's police lab handled 182 cases of buprenorphine seizures, a 214 percent increase from the 58 cases it processed in 2006. Methadone submissions decreased 45 percent, to 61 cases. Oxycodone, whose main brand OxyContin has been widely abused, was identified in 222 cases, a 6.7 percent increase.

Baltimore County's drug lab processed 65 buprenorphine cases last year, a 103 percent increase from 2006. Cases involving methadone increased 12 percent, to 46, while Oxycodone submissions rose 15 percent, to 176 cases.

Officials cannot say how many criminal cases arose from Suboxone seizures. Court records do not catalog them by drug name.

But The Sun was able to identify several such cases, most near Lexington Market. On Jan. 9, police arrested a 31-year-old woman after officers found two dozen Suboxone pills and a prescription bottle with a scratched-out label. On Jan. 24, a 53-year-old man was arrested holding a bottle - with an "obliterated" label - containing 38 Suboxone pills and $302 in cash.

By comparison, heroin and cocaine seizures accounted for a combined 22,000 cases last year in the city and 2,100 cases in Baltimore County. But addiction experts say the upward trend of "bupe," Suboxone's street name, must be heeded.

"It's important to learn from the numbers, even though they may not be huge," said Michael M. Gimbel, director of substance abuse education at Sheppard Pratt Health System. "They show enough of a dramatic increase to ask questions: How is it getting it on the street? Where is it coming from? And how can we stop or slow the diversion?"

Officials responsible for promoting development and use of Suboxone long played down its potential for misuse. But that's changing. At a February conference in Washington, federal officials said they might change warning labels and improve detection methods and training for doctors. Unlike methadone, which is typically dispensed at clinics, doctors can prescribe months-long supplies of Suboxone.

"We must address this issue of diversion," said conference participant Dr. Elinore F. McCance-Katz, president of the American Academy of Addiction Psychiatry. "If this drug is seen as something that is potentially harming the public, we want to get in front of that. As physicians we need to look at this very carefully."

Baltimore Health Commissioner Dr. Joshua M. Sharfstein and state health officials are spending millions of dollars on Suboxone treatment. He said lab statistics do not necessarily indicate street sales because some seizures are from people with legal prescriptions.

Sharfstein said Suboxone on the street presents less danger than methadone, which leads to vastly more overdose deaths.

"I think diversion [of prescription drugs] is an important issue," Sharfstein said. "But it has to be put in the context of the heroin problem."

Charles F. Cichon, executive director of the National Association of Drug Diversion Investigators in Manchester, said: "It absolutely surprises me that law enforcement seized more buprenorphine than methadone. To the best of my knowledge, this is not typical for ... [police] around the country."

Nationally, methadone is submitted to drug labs far more often than buprenorphine, Drug Enforcement Administration data show. But bupe submissions are increasing at a faster rate - 114 percent from 2006 to 2007. Methadone increased 7 percent.

Senior Baltimore city and county police officials say they are not alarmed by buprenorphine seizures, but officers on the street are increasingly seeing bupe.

Baltimore County's lab processed 21 cases from January to March. The city drug lab logged 58 cases by mid-March.

"It's on its way. It's the up-and-coming black market drug," said Baltimore County narcotics Detective Patrick Covahey.

Officials in other parts of the nation - especially New England - said last year that addicts abuse Suboxone to get high or to avoid withdrawal until they use heroin again. The April 1 drug bust in Wise County, Va., is one of a growing number of such cases.

All seven of the suspected dealers were selling pills obtained by prescription, said Richard Stallard, director of the Southwest Virginia Drug Task Force. His region was among the first to see widespread OxyContin abuse, and officials fear Suboxone may be following that pattern.

"I describe the oncoming of Suboxone as the same as with OxyContin," Stallard said. "OxyContin started with something you heard a little bit about selling at a high price, then you heard a dramatic increase of the amount being trafficked."

doug.donovan@baltsun.com fred.schulte@baltsun.com

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