Doctors and addicts

August 11, 2006

Despite widespread acknowledgement of its effectiveness, a drug that counteracts heroin cravings has had limited availability. But there's a national push for greater use of the drug, and Maryland health officials are prudently on the bandwagon - and may offer some leadership as well.

The drug is buprenorphine, a synthetic opiate that has proven to be an effective antidote to heroin as well as prescription painkillers such as Oxycontin. Prescribing the drug and managing its use can be done through individual doctors, teaching hospitals, community health centers and group practices. After initially restricting buprenorphine treatments to only 30 patient-addicts at a time, Congress lifted the limits last year on hospitals and other entities, but not for individual doctors. That's an unfortunate lapse that should be corrected. A recent federal evaluation reconfirms the drug's effectiveness in combating addiction and the need for more doctors to become part of the treatment solution.

Here in Maryland, efforts have been under way to get the drug to more addicts, particularly through hospitals, health centers and private physicians. Heroin poses major problems not only in Baltimore, but on the Eastern Shore and in Western Maryland as well. The Center for a Healthy Maryland, which is part of MedChi, the state medical society, is rightly engaged in an extensive outreach campaign to educate doctors about buprenorphine's promise.

Baltimore is also embarking on an ambitious project to give more addicts buprenorphine in treatment and move them into primary care under a doctor's watch. The city plans to provide $250,000 to train doctors and to cover some patient insurance costs, a far more cost effective approach than the hospital emergency room care many addicts now get. As Baltimore and Maryland refine their models of treating addiction as a medical problem and using buprenorphine as a medical intervention, they may have lessons to teach beyond their boundaries.

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