For docs, a chance to heal a community

October 08, 2006|By DAN RODRICKS

Dear Maryland doctors: I drive past St. Dominic Church in Hamilton, Northeast Baltimore, now and then, and each time I do, I remember one of your colleagues, Sebastian Russo, the last of the "five-dollar docs." I attended his funeral at St. Dominic's and, God help us, it was more than 25 years ago now -- Feb. 27, 1981.

You would have admired this man, though some of his habits might seem almost too quaint to mention today. He treated many patients with no expectation of being paid. He had no computerized billing system. He had no weekend answering service; people could call him at any time, and he'd answer the phone. He avoided prescribing drugs as a quick solution to ailments.

Sebastian Russo visited the old and the sick. He was a doctor without borders -- he treated anyone who walked in, the priest at his funeral said, even "a thuggy creature from the street."

Someone like that killed Sebastian Russo.

Someone carrying a concealed weapon shot the doctor in his office on a Friday night, and though police have never solved the crime, they suspected that the killer was an addict looking to steal drugs, or money for drugs.

In the 25 years since Sebastian Russo's death, there have been thousands of drug-related homicides in Baltimore, through the terms of four mayors, one who became governor, another who seeks that office this year.

The number of Baltimoreans thought to be addicted to heroin and cocaine reached about 65,000 in 1999, though more recent estimates have put the number at about 40,000.

We have sent thousands of men and women with drug problems to prisons throughout Maryland, and they are so crowded that there's talk about building another federal facility near Baltimore.

Between 1999 and 2003, the state increased public funds for drug treatment, but according to a recent study by the Justice Policy Institute, Maryland invests only 26 cents in the treatment of abusers for every $1 spent on punishing them.

I know that many doctors agree that opiate addiction is a serious -- perhaps our most serious -- public health problem. The illegal commerce in heroin contributes to homicides and nonfatal shootings. Heroin addiction leads to the spread of hepatitis and HIV, and to overdose deaths. It contributes to family dysfunction, domestic violence, prostitution, homelessness and child neglect.

Doctors are well aware of all these problems.

Many of you -- even in the deep suburbs -- have treated men, women and children whose bodies and minds have been damaged in some way by drug addiction.

But only a small percentage of you have had an opportunity to treat the problem at its source, among the addicts themselves, up close and personal with those who want and need help.

Now you have such a chance to make a difference -- one man, one woman at a time.

If you'd like to get involved in one of the most important public health efforts in Maryland, then you should call Dr. Josh Sharfstein (410-396-4387).

Sharfstein is the doctor who has been running the Baltimore Health Department since Peter Beilenson's departure. Sharfstein is looking for doctors willing to be trained and certified in prescribing a drug that holds great promise in the treatment of heroin addiction and painkiller dependency.

If you've been keeping up with things, you've probably heard about it. It's call buprenorphine, commonly known as bupe.

One of our congressmen, Elijah Cummings, has been on top of the bupe effort for the past few years. He was the lead sponsor of legislation that allowed you guys to prescribe bupe out of your offices to up to 30 patients each.

In the world of substance abuse, this was a huge development.

But fewer than 90 physicians in Baltimore have been trained to prescribe bupe. Howard County received foundation money for training last year, but only seven doctors signed up.

Unlike methadone, the other pharmaceutical treatment for heroin, addicts do not have to visit a clinic every day to get their dosage; bupe can be taken at home instead. It is considered harder to abuse and easier to discontinue than methadone, and it leaves its users feeling clear-headed.

"Recently," Cummings reported the other day, "the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services released the results of an evaluation of buprenorphine. Of more than 350 patients treated with the medication, 59 percent were abstinent from all drugs after six months. When asked if they would recommend buprenorphine to other opiate addicts, 97 percent of the patients said yes."

I've heard the same from a handful of addicts who've had the treatment.

And that's my point -- we've only reached a handful of the addicts out there.

If more doctors learn about this drug and prescribe it, more addicts will get it, and we might actually blow a big hole in the demand for illegal drugs in Baltimore and throughout Maryland.

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