"We don't anticipate there are many deaths [in methadone clinic patients]," said Mark W. Parrino, president of the American Association for the Treatment of Opioid Dependence. "We're very happy to cooperate."
How much information the government will be able to garner about buprenorphine is less clear.
Buprenorphine, sold mainly under the brand name Suboxone, has been on the market since late 2002. It is prescribed to about 170,000 people, either through clinics or several thousand specially licensed doctors, who would not be part of the reporting system.
Federal officials consider buprenorphine much safer than methadone and are encouraging more private physicians to begin using it to treat addicts. Though it also can suppress breathing if abused, Suboxone has a ceiling effect that limits the danger of overdose as more is consumed. But that effect diminishes when the drug is taken with tranquilizers and other drugs.
Buprenorphine enjoys wide political support. That's especially true in Baltimore. Earlier this week, Mayor Sheila Dixon requested $5 million from the Maryland General Assembly to greatly expand buprenorphine treatment.
Yet Maryland authorities have paid little attention to the drug's emergence as a street commodity.
Some patients illegally sell the orange, hexagonal tablets after receiving them to take at home. Some abusers use the pills to get high or to tide them over when they can't find heroin or other opiates.
Deaths from mixing the pills with other drugs also are likely to escape scrutiny in most states, including Maryland, where medical examiners lack the lab equipment to detect the drug.
The Sun series reported that the drug's manufacturer knew of 13 deaths since the start of 2005 from taking buprenorphine in combination with other drugs. The newspaper uncovered two such deaths the company didn't know about. They occurred in Vermont, the state with the nation's highest rate of buprenorphine use.
Reuter, the SAMHSA official, conceded that the new surveillance system is not likely to capture much information from private doctors, who are not involved in the reporting system but are prescribing most of the buprenorphine used to treat addicts.
A few medical examiners around the country are considering adding tests for buprenorphine as overdose deaths related to abuse of the drug begin to surface.
Dr. Steven Shapiro, Vermont's medical examiner, began this month to test for buprenorphine in every suspected overdose death.
