Expanding buprenorphine access is a key step in Baltimore's long struggle against addiction

As the scourge of addiction continues to claim hundreds of lives in Baltimore City, health officials are racing to expand access to buprenorphine, a medication that blocks addicts’ craving for heroin and other opioids. There’s no silver bullet to solve the city’s mounting epidemic of drug overdose deaths; there were 694 such fatalities last year — more than double the number killed by violence over the same period — and the toll keeps rising. But buprenorphine can significantly reduce overdose fatalities as part of a comprehensive approach that treats addiction as a disease rather than a crime, and the city must do whatever it takes to make sure everyone who needs it can get it.

Buprenorphine is just one of a range a medications that also includes methadone, an effective but highly addictive heroin substitute, and naloxone, an anti-overdose medication that can reverse the effects of opioids as well as powerful street drugs such as fentanyl. And it’s important to recognize that none of them by themselves can wean an addict off drugs. But when combined with clinical interventions and therapies that aim to change behavior, manage stressors and increase coping skills in a supportive environment, they can make it easier for people at risk of overdose to kick the habit.

In order to expand access to buprenorphine, city health officials will need to greatly increase the number of doctors who can prescribe the medication, however. Baltimore Health Commissioner Dr. Leana Wen estimates there currently are fewer than 100 city physicians who have the training and certification to prescribe the drug, and even they are limited in the number of patients they can treat. “It makes no sense that doctors can’t prescribe treatment for opioid addiction just as they would for any other illness,” Dr. Wen says. “There’s a lot more than can be done in medical and health care settings, and we’re working with hospitals and health care systems to treat addiction as a chronic disease.”

The city also needs to make buprenorphine accessible in more “low barrier” settings such as homeless shelters and mobile health units. Going to a doctor’s office can be a real challenge for some addicts, and the city needs to find new ways to reach people where they are rather than making them come to it. That means expanding the number of neighborhood primary care offices and different types of therapeutic settings, especially outpatient mental health clinics and opioid treatment facilities.

Baltimore health officials also recognize the need to make buprenorphine available in hospital emergency rooms for people who come in for other reasons. That’s a critical area where the city needs to be able to offer anyone who asks for it drug treatment on demand, either by dialing up a hotline to find an available treatment slot or by transferring patients to a stabilization center open 24 hours a day, seven days a week, where they can receive social services and resources for further care until a treatment bed becomes available.

None of this will happen overnight. The city is working closely with the federal Health and Human Services Department’s Substance Abuse and Mental Health Administration as well as with state government and private donors to establish a $3.2 million, round-the-clock stabilization center scheduled to open next year. And it will take years more to recruit all the physicians who will need to be trained and certified to prescribe buprenorphine. But Dr. Wen insists Baltimore City is in the struggle to reduce drug overdose deaths for the long haul. It’s an ambitious goal, and expanding access to potentially life-saving medications such as buprenorphine is an important first step in the right direction.

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