Saturday Mailbox

SATURDAY MAILBOX

December 22, 2007

Addiction poses greater dangers

Not one person. Despite pages of text arguing that the misuse of buprenorphine is a crisis, The Sun interviewed nobody in Maryland whose initial or primary problem is abuse of the medication ("The `bupe fix,'" Dec. 16-18).

Not one good comparison. The Sun provided no information to help readers contrast the street market for buprenorphine with our major heroin problem or with the diversion of more addictive, more lethal and less regulated drugs, such as OxyContin.

Not one stereotype of drug treatment left out.

The Sun perpetuated the myth that addiction therapy must either be perfect or a failure.

Instead of accurately describing buprenorphine as a long-term medication proved to treat addiction to heroin and other opiates and supported by an international medical and public health consensus, The Sun suggested that its benefits are "still being assessed."

The newspaper even attributed to unnamed "clinic directors" the demonstrably false statement that "people treated with [buprenorphine] do no better or worse than addicts on any other type of treatment."

Stringing together anecdotes, The Sun branded treatment programs as places for hustling, not healing.

Patients "sell a portion of their pills to raise cash or buy drugs" and "plead for large quantities of the pills to take at home." A French physician is quoted describing himself as a "legal dealer."

The series then cites unnamed "critics" who say buprenorphine "doesn't address the underlying problem of opiate dependence."

This is a dangerous deception. The underlying problem is addiction - characterized by loss of control, crime, family breakdown, and community harm. The underlying problem can be seen in a boarded-up block, a pair of siblings forced into foster care, a neighbor dying from AIDS. The underlying problem will not be solved until the stigma of treatment recedes.

Yes, it is our job to continually improve our monitoring and control of buprenorphine diversion. As with any other medication, the challenge is to maximize the benefits of buprenorphine while minimizing its risks.

But let us move forward without hysteria, imbalance and ignorance. Let us respect the doctors, nurses and counselors who use this effective medication to help save lives. And let us remember that if we can expand access to care that works, more people who are drowning in a sea of addiction will reach the shore.

Joshua Sharfstein Peter Luongo Baltimore

The writers are, respectively, Baltimore's health commissioner and the director of the state's Alcohol and Drug Abuse Administration.

The Sun's series on the abuses of buprenorphine distorts the true picture of an extremely promising therapy for heroin addiction.

Given the high social costs of addiction, the United States has embraced buprenorphine as an effective treatment, after carefully examining the experience of France and other countries. And a number of extraordinary controls guide the use of buprenorphine in this country.

As a result, buprenorphine is extremely safe when used properly. And thousands of people use buprenorphine appropriately and therefore safely. It has helped them turn around their lives.

In the process, it has saved the public all the negative health consequences and costs of heroin addiction, from HIV transmission and emergency room visits to property crime and incarceration.

The Sun should also cover these successful stories.

Diana Morris

Baltimore

The writer is director of the Open Society Institute-Baltimore, which funds buprenorphine treatment and other drug treatment programs.

In The Sun's recent series of articles on buprenorphine, the many positive aspects of buprenorphine seem to have been lost in the overwhelming focus on its negatives.

The first and most important of these positive aspects is the number of studies that have shown how effective the medication is at helping people stop using heroin and prescription pain killers.

The diversion of buprenorphine, although an issue, must be put in the context of the illicit sale of other medications - for instance, there is even a black market for antibiotics and asthma inhalers.

As for safety issues, in the United States, there is little evidence that buprenorphine causes or even has a substantial contribution to the reported "buprenorphine-related deaths," and there are no cases of deaths related solely to buprenorphine - unlike the more than 1,000 deaths per year as a result of heroin and other prescription painkillers.

Dr. Christopher Welsh

Baltimore

The writer is a professor at the University of Maryland School of Medicine.

Yes, addicts will be addicts. Yes, I've heard of adults huffing paint, shooting Viagra, smoking crumbs from the carpet and even, occasionally, of somebody abusing "bupe" - all in a desperate search for any kind of high to substitute for their elusive drug of choice.

But let's get real: No hard-core (or any-core) addicts are seriously seeking Suboxone for steady consumption.

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