Baltimore Health Department seeks to double buprenorphine treatment

Baltimore health officials want to double the number of people in the city who can get access to the addiction treatment drug buprenorphine, help they say heroin addicts desperately need.

Officials estimate that 25,000 people in the city are addicted to heroin or other opioids. Numbers on how many people are currently getting buprenorphine in Baltimore were not available, but officials said that even doubling the number of patients with access would not close the gap entirely.

Gabriel Auteri, deputy chief of staff of the city health department, outlined the plan to make buprenorphine more widely available Tuesday before the City Council’s public safety committee.

“Expanding access to treatment means making sure not only that there is enough capacity to meet the needs, but also making sure that we’re able to get people into treatment the moment that they’ve decided they’re ready, without long waits that often lead to deadly consequences,” Auteri said.

The effort has taken on more urgency as city officials grapple with soaring overdose deaths, driven largely by an increase in the use of the unpredictably potent synthetic opioid fentanyl.

The result is that overdoses now kill far more people than violence on the streets each year: The city logged 694 fatal overdoses in 2016. Most involved fentanyl. The figures are set to rise again this year. Deputy Baltimore Police Commissioner Dean Palmere told committee members the city had suffered 632 fatal overdoses so far in 2017, 396 involving fentanyl.

Committee member Shannon Sneed said it was important to hold a hearing so the council could better get to grips with the issue.

“Every community meeting I go to, this issue constantly comes up,” she said. “Constituents want to know, what are we doing? What’s going on? Does the city know what’s going on? Does the city care about what’s going on?”

While methadone may be distributed only at specialized clinics, which sometimes attract opposition from their neighbors, buprenorphine can be given out by at a doctor’s office. But under federal rules, doctors have to undergo special training and get permission to prescribe the drug. Those rules limit those who get authorization to treating 275 people at a time.

Doubling capacity wouldn’t mean just recruiting more prescribers, Auteri said, but also providing other services for new patients. Auteri said the health department will provide support to doctors whose patients might need housing, mental health treatment and job training. He didn’t say how much that aid might cost, but said the program would be funded by the state, and would be “insignificant compared to the benefit we’ll be able to accrue.”

It’s not clear whether the plan needs Mayor Catherine Pugh’s approval. A spokeswoman for the health department said it would, but Auteri said it was ready to launch. Pugh spokesman Anthony McCarthy said the mayor “is committed to providing as many resources as possible as Baltimore and the country battles against opioid addiction.”

Auteri said the health department wants to adopt a “hub and spokes” model for distributing the drug, involving central facilities that would stabilize patients and develop a plan for them before passing them along for longer-term treatment to smaller providers.

Even as they have pushed to make more treatment available, officials have said they don’t have a good grip on what resources are available at any given moment. Auteri said an online dashboard with current data is expected to launch within the month, and should help get people into treatment more quickly. He said the department plans to begin providing buprenorphine to some 50 patients in its HIV/AIDS clinics soon.

Federal authorities say buprenorphine can be abused, and it has sometimes proven a headache for Maryland prison officials because it comes as a film that is easy to smuggle behind bars. The state responded to that problem by pulling the film from a list of drugs covered as standard by Medicaid, but later reversed that move.

The city is planning a stabilization center that could be used to treat people in an emergency rather than sending them to the hospital. And officials have moved to significantly boost the availability of the overdose-reversing drug naloxone.

Pugh has said she wants to keep drug treatment out of neighborhoods, clashing with some in the health profession.

Auteri said the health department wants to meet addiction patients where they are, but is aware of concerns communities might have about treatment, and so created a work group to try to iron out worries.

“We know we need more treatment in the city, and to help make sure that treatment providers are responsive to community needs,” he said.

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