How Sun took on bupe




There might be no issue more challenging in Baltimore than the social and economic devastation wrought by the city's drug epidemic. So it's not surprising that the recent arrival of buprenorphine, a drug designed to help wean addicts from heroin, was greeted with excitement and hope.

But the increasing number of prescriptions written by doctors has come with dangerous side effects. A months-long investigation by Sun reporters Fred Schulte, Doug Donovan and Erika Niedowski about the use of "bupe," as it is called on the street, revealed some disturbing social trends.

The series showed that bupe, primarily prescribed in a form called Suboxone, is being abused here and elsewhere around the world, much like the drugs it was designed to replace. In "The `Bupe' Fix," a three-part series that began last Sunday, the Sun reporters produced a cautionary tale about what has been hailed as a wonder drug.

The series did note the experiences of addiction experts and addicts themselves, which showed that bupe is very effective in alleviating cravings for heroin and pain pills like OxyContin, and for preventing the sickness of drug withdrawal. But the reporters also found considerable evidence of the drugs' abuse.

The series raised the question of whether government and health care agencies have failed to recognize the extent of bupe's misuse. Assistant Managing Editor John Fairhall, who supervised the series, said: "It was not an attack on the drug. The series was designed to examine the way the government is making it available, with few restrictions, and the consequences of this approach."

Nonetheless, the articles sparked a crossfire of comment and controversy on the newspaper's Web site and in e-mails sent to the newsroom. Critics said the series was one-sided because it failed to give enough credit to Suboxone's benefits in fighting heroin addiction.

Rebecca Ruggles, a manager for Mid-Atlantic Association of Community Health Centers, said: "The Sun's series of articles on buprenorphine was a shocker. But unlike the readers you were probably trying to attract, I was shocked not by the anecdotes of abuse and street sales that you chose to highlight, but by your stooping to this kind of sensational journalism. The truth is buprenorphine (Suboxone) is one of the safest and most effective treatments we have for a disease that is life-threatening. Lives are being saved by this new medication; people are being restored to productive work and healthy relationships by receiving it. Deep in these articles are references to the difficulties of balancing public health impacts -- and the fact that there is no risk-free strategy. Then the articles quickly return to emphasizing instances of harm, instead of the science and the data, the weighing of risks and benefits. There was a clear alternative -- a way The Sun could have raised these issues to juxtapose the benefits and the risks -- and to help readers understand the complexities of the public health challenge of treating addiction. You decided instead to go for shock value."

From Tim of Farmington, Conn: "Very comprehensive article, but the tiny amount of misuse and resulting consequences are overshadowed by the overwhelming good this treatment has brought to hundreds of thousands."

Others praised The Sun's reporting.

Said Percy Menzies: "Bravo for these great articles, and for writing with such accuracy and balance. Few people are aware that buprenorphine is becoming one of the most abused pharmaceuticals in the world."

From Mehboob Singh of India: "During my one-year stay in Baltimore for a fellowship program in substance abuse prevention and treatment, I was astonished by the way buprenorphine was being promoted for the management of opioid addiction. During my five-year work experience in the field of addiction medicine in India, buprenorphine was one of the most commonly abused drugs among the intravenous drug users. Its promotion needs a more cautious approach."

The idea for the series began earlier this year when Schulte, a veteran investigative reporter who had encountered material documenting buprenorphine abuse, suggested that the newspaper investigate its impact as an addiction treatment.

Reporter Donovan joined Schulte and was assigned to focus on New England, where the drug has been extensively prescribed to addicts. Donovan and Sun photographer Doug Kapustin traveled to Vermont and Massachusetts, where they documented street sales and misuse of bupe. They accompanied a Worcester, Mass., police officer on Suboxone undercover buys and spoke with doctors, state officials and addicts.

Meanwhile, in Part Two of the series, foreign correspondent Erika Niedowski examined the effect of bupe internationally -- it is available in more than 40 countries. Niedowski reported from France, which has the longest experience with bupe and which U.S. officials have seen as a model.

Part Three of the series, "Not a cure-all," focused on the need for other forms of treatment in addition to bupe, especially therapy and counseling. It also examined Baltimore's efforts since it began its buprenorphine program in October 2006 under the direction of City Health Commissioner Dr. Joshua M. Sharfstein.

An online reader from Rosedale wrote, responded: "I work in health care and I can assure you that The Sun is on to something."

In my view, this series showed there is no magic bullet to defeat heroin addiction and it is a comprehensive effort to rebuild lives and communities that will be required.

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