A promising treatment

During the recent lame-duck session, Congress took a big step toward getting an effective antidote to heroin and other addictive substances within reach of more users by increasing the number of addicted patients that private doctors can treat with the promising drug buprenorphine. It's a welcome development for addicts across the country, but especially in Baltimore where the problem is so acute.

Like methadone, buprenorphine is a synthetic opiate that has helped addicts kick the habit. Unlike methadone, however, buprenorphine does not have to be dispensed through a clinic but can be taken at home because it is less likely to be abused. Its effects last longer so it doesn't have to be taken daily, and it can be discontinued within months, not years.

Yet Congress has taken an overly cautious approach to making the drug more widely available, based on initial worries about abuse. As the comfort level has increased with the drug's proven effectiveness, restrictions have eased on the number of patient-addicts hospitals can treat. And this month, the limits on such patients for individual doctors were allowed to go from 30 to 100.

Baltimore has been the key focus of an ambitious statewide outreach campaign to train and certify more doctors to use buprenorphine. Nearly 50 doctors in the city have completed an eight-hour course in preparation for dispensing the drug. But with as many as 40,000 heroin users in Baltimore and only about 1,000 on buprenorphine, the drug has hardly realized its potential.

Getting more doctors involved is important to the city's effort to deal not only with addiction but with other health concerns as well. Once an addict starts seeing a doctor for buprenorphine, he might receive treatment for diseases such as diabetes or AIDS that can be managed much more effectively - and less expensively - by primary care physicians than in hospital emergency rooms. Now that Congress has more fully recognized buprenorphine's promise for saving lives and money, doctors have to step up and make sure that the promise is fulfilled.