Barriers to `bupe'

A new study finding that private physicians in Maryland are having difficulty dispensing a promising drug to help heroin addicts throws light on problems that should be fixed. The potential for more doctors to help addicts kick their habit is too great not to remove procedural red tape and other obstacles.

The drug, buprenorphine, is a synthetic opiate that helps reduce painful symptoms of withdrawal. One of its key advantages is that, unlike methadone, it doesn't have to be dispensed through a clinic, but can be taken at home. However, it must be prescribed and managed by some medical entity, such as a teaching hospital, community health center, group practice or individual doctor. Maryland has launched an ambitious effort to train and certify more private doctors who can dispense the drug, which is also effective against prescription painkillers that can become addictive, such as OxyContin.

But the investigation by the Center for a Healthy Maryland Inc. found that many health care providers don't appreciate the chronic nature of addiction and the need for long-term treatment. Providers and insurance companies also forced some doctors to wait two to three days for a green light to use buprenorphine, even though it's approved under Medicaid. Some doctors also had to foot the bill for the drug because of delayed payments, rather than disappoint a patient who was ready for treatment. Other doctors hesitated to treat addicted patients because the time and attention they demand were not adequately covered by providers' reimbursement rates.

Baltimore has managed to avoid many of the obstacles identified in the study by referring most buprenorphine patients to private physicians only after they have started out in buprenorphine-oriented treatment programs. By the time a patient is ready to be cared for by a doctor, the city has dealt with the Medicaid providers and cut through most red tape.

But that may not be possible for patients in suburban or rural areas where a private doctor is the only option for buprenorphine because group treatment programs aren't available. That's why the center, an affiliate of the state medical society, is smartly using the study to bring doctors, providers, insurers and other interested parties together on behalf of patients who need more, not less, access to a promising heroin antidote.