Baltimore's health commissioner told the city's top criminal justice leaders yesterday that his agency will do more to minimize street sales of buprenorphine, an addiction treatment drug for which the city and state are spending millions of dollars.
Commissioner Dr. Joshua M. Sharfstein has said that misuse of the drug is not a public health problem, but that he will take specific action to reduce street sales - called diversion - as the city expands buprenorphine treatment.
"It's available on the street," Sharfstein told the Baltimore Criminal Justice Coordinating Council at a presentation at the downtown courthouse. "We know this is happening. We're trying to limit diversion. I'm not happy about it but I don't think it's a public health crisis."
Sharfstein provided a document to the panel that spelled out three steps on how he plans to minimize diversion: meet regularly with police about the buprenorphine and other drugs on the streets; review the manufacturer's quarterly reports monitoring misuse; and examine overdose deaths associated with alcohol and depressants such as sedatives, which can be deadly when mixed with buprenorphine.
Sharfstein has previously said that he also wants Maryland's medical examiner to routinely test for buprenorphine, commonly sold under the name Suboxone, in overdose deaths. In addition, he intends to track test results showing whether patients are taking their buprenorphine.
A three-day series in The Sun last month described how Suboxone prescribed for treatment is being sold by patients on the street, leading to growing abuse of the narcotic. Addicts also are injecting and snorting buprenorphine, according to health officials in several states and research from the drug's manufacturer. Illegal sales and abuse remain far below other abused narcotics but are on the rise, especially in areas of the country where the drug is most heavily prescribed, those sources say.
"It's a very fair question to ask what we're doing to minimize the risk because buprenorphine comes with risks," Sharfstein said. "The benefits strongly outweigh the risks. If we're cavalier about the risks it could undermine support about the benefits."
His comments come a week after Mayor Sheila Dixon asked the General Assembly to allocate $5 million to increase the number of city addicts treated with the narcotic each year from about 650 to 2,500.
