Vice Squad
Friday, June 22, 2007
Bupe in B-more

In 2002, new FDA rules made it possible for doctors to meet in their offices with addicts, and to prescribe the opiate agonist buprenorphine. In the form prescribed, the buprenorphine is combined with the antagonist naloxone, thereby rendering the compound ineffective in taking by injection for a high. Unlike methadone clinics, which generally require daily visits by patients, addicts treated with the bupe/naloxone mix could receive a month's supply at a time.

Vice Squad hometown of Baltimore, Maryland, is racked by a terrible heroin problem. In October, 2006 Baltimore announced that it was going to promote buprenorphine treatment for heroin addicts; the state of Maryland has earmarked $3 million for bupe treatment in the coming fiscal year. Unfortunately, Maryland doctors do not seem all that eager to climb aboard the bupe train, and those that do board find the journey to be arduous, according to an article this week in the Baltimore Sun:
"One of the biggest barriers to prescribing buprenorphine is dealing with the insurance companies," said Dr. Christopher Welsh, a psychiatrist and assistant professor at the University of Maryland School of Medicine in Baltimore. Welsh uses the drug to treat patients at the university's hospital. Some come from hundreds of miles away to get a prescription, only to have their treatment thwarted by red tape.

"A few hours later, you'll get a call, and the patient will tell you that the pharmacy said the prescription wasn't authorized," said Welsh, who participated in the survey.

He added that a physician who intervenes to help the patient is often "passed from voice mail to voice mail" by the health care provider, and the experience "can be very time- and labor-intensive."

Two years ago, Vice Squad noted a prescient Wired article detailing barriers to the spread of bupe treatment for heroin addicts.

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