Bupe probe has politicians seeking answers (Baltimore Sun)

By Fred Schulte and Doug Donovan

Two U.S. senators from New England are calling for action to reduce misuse of buprenorphine, a narcotic that federal officials are promoting for treatment of tens of thousands addicted to heroin and pain pills.

In Maryland, two key lawmakers said today that they will question health officials about abuse of the drug and state spending on it when the General Assembly convenes next month in Annapolis.

The responses follow a series of articles this week in The Sun, which showed that while many experts champion buprenorphine as a highly effective addiction medicine, the drug is starting to cause some of the kinds of problems that it was created to solve.

Authorities say that some patients illegally sell the orange, hexagonal pills of Suboxone after receiving them by prescription. Longtime heroin addicts and youthful buyers in suburban and rural areas are using the drug to get high and to tide them over when they can't find heroin or other opiates. Some snort or inject Suboxone, the series reported.

While illicit sales occur in many communities, including Baltimore, the problem is growing in New England, where the drug is most extensively prescribed. Police in Worcester, Mass., said bupe is becoming a popular street commodity.

"This is a disturbing report, and we need to review it and get some answers," Sen. John Kerry, a Massachusetts Democrat, said today in a statement. "By being vigilant and proactive, and working with law enforcement and the medical community, we can make sure that what may be an emerging trend in Worcester and other cities doesn't become an epidemic."

Sen. Bernard Sanders, a Vermont independent, said officials in that state "must make sure that there is better evaluation and monitoring of patients." He said that while buprenorphine is an effective treatment that shouldn't be abandoned, the state "must evaluate its program with respect to prevention, treatment, and diversion issues."

Suboxone is the centerpiece of a government effort to shift opiate addiction treatment away from restrictive clinics to private doctors' offices. The federal government spent at least $26 million to help develop buprenorphine in partnership with Reckitt Benckiser Pharmaceuticals Inc., a Richmond, Va.-based subsidiary of a British company.

The pills reduce cravings for opiates and ease the sickness that addicts feel when they stop using them. Addicts often say they feel "normal" when using the tablets, which are meant to be dissolved under the tongue.

Reckitt Benckiser officials acknowledge that misuse is on the rise. But focusing on illegal sales tends to obscure "the enormous good that has already come to hundreds of thousands of opioid-dependent individuals worldwide," the company said in a statement.

Baltimore Health Commissioner Dr. Joshua M. Sharfstein said buprenorphine saves lives from heroin addiction, "one of the most devastating diseases in our city." He directs a government-funded initiative that has dispensed the drug to nearly 700 addicts and intends to eventually treat thousands.

He disputed the series' finding that illegal buprenorphine sales are an increasing problem, saying that heroin and other prescription opiates are a far more serious concern.

"There's definitely gaps in Baltimore in surveillance" of illegal Suboxone sales, Sharfstein acknowledged. "We're working on that ... to limit the risks and maximize the benefits."

Little is known about the full extent of buprenorphine abuse in Maryland because nobody tracks it. State officials, citing federal Drug Enforcement Administration data, said that in the past six months only "20 buprenorphine pills" have been seized in Maryland. Yet in one Baltimore arrest in August, city police seized 24½ Suboxone pills from a man they said was selling them from his car on Pennsylvania Avenue.

"There's a high demand for it on the street. Walking through the streets, you have people who come by, asking: 'Do you have any bupe to sell?'" said Valarie Clark of West Baltimore, a recovering addict now taking Suboxone in treatment. She testified on the drug's benefits before the City Council last summer.

Police officers say they are seeing more of the drug near Lexington Market and in open-air drug markets near Pennsylvania Avenue and Oldtown Mall.

Maryland is spending $3 million to expand buprenorphine treatment across the state and has spent at least $750,000 to help pay for low-income patients' pills.

State Sen. Thomas M. Middleton said he intends to bring Maryland health officials before his committee to address the concern that addicts sell pills paid for with state money.

"I think even a liberal Democrat would have concerns with taking tax money for a program that people take and profit by," said Middleton, a Democrat from Charles County who chairs the Finance Committee. "That goes against all of our beliefs. Especially in times of very limited resources."

Del. Peter A. Hammen, a Baltimore Democrat and chairman of the House Health and Government Operations Committee, said he will bring up buprenorphine issues at the start of the legislative session next month. It is important to make sure that addicts have access to treatment, he said, "but we don't want to have abuse."