Jeffrey A. Schaler, Ph.D.

In The News

Buprenorphine Program Aimed at Reducing Heroin Addiction, Drug-Related Violence

By Sarah Richards
WYPR News in Maryland, 88.1 FM, National Public Radio station
February 28, 2007
Click here to go the WYPR website and hear sound portions

BALTIMORE (2007-02-28) BODY: TAPE: (4 SECONDS), MINIDISC 1, TRACK 6, 5:34 - 6:10
IC: Let me see that? For the people that just came in, this is what happens to a person that come off heroin, get on buprenorphine and stop and change their life. "The Community College of Baltimore County, this award of recognition is presented to this young lady for successful completion of human services training" Applause

Eight men and women are sitting around a table at the Park West Medical Center in Reisterstown. They're celebrating a former drug addict's academic comeback. That comeback is due in part to a drug called buprenorphine.

IC: It works, it works. You just put them on your tongue and let them dissolve

That's Mike. He's 48 years old, and he's agreed to be interviewed on condition that his last name not be used. He attends a different counseling group, but, like Park West's, the idea is the same: to get off heroine. After several attempts, Mike finally did in 2004, thanks in part to buprenorphine, or "bupe" for short. Bupe is different from methadone. It's not as addictive, so Mike can get it off a general practitioner. And unlike methadone, it won't add to your high if you use heroin at the same time.

IC: If you're taking bupe it's a waste of money if you try to get high because it's going to block it. I even experimented to see and it works.

Bupe is one of the newer tools in Baltimore's never-ending shot at redemption. The city is pinning big hopes on bupe. Joshua Sharfstein is the city health commissioner.

IC: Our interest in this comes from the expert opinions of countless federal agencies and substance abuse experts who have looked at this and looked at the experience of places like France, where the number of drug overdose deaths dropped from 500 to over 150 in a few years after bupe became widely available.

But Baltimore's bupe program aims to do more than get people off drugs. Addicts who have gone through at least three months of detox will be set up with a primary care doctor. Doctors will not only prescribe them bupe, but also treat other health problems they may have. Adam Brickner is the president of Baltimore Substance Abuse Systems.

IC: It's going to be a huge cost savings to the community. Because most of these guys are uninsured, most are male, the only time they access the healthcare system is through the emergency department, which is the most expensive way for them to access care.

It's a great idea. But let's go back to that part about being uninsured. Many doctors don't want to deal with drug users because of that. Plus, they often have serious health problems, like HIV. It's for these reasons that the city is now paying doctors to be trained on how to prescribe buprenorphine. But drug treatment programs are always controversial, and this one is no different.

IC: Treating opiate addiction with bupe is like treating scotch addiction with bourbon. You're substituting one drug for another.

Jeff Schaler is a professor at the American University School of Public Affairs. He believes people take drugs because of their behavior and environment. He says even if a government could solve all the problems that lead people to use drugs-- things like racism and money issues that wouldn't stop some people from using. He believes the best solution is to legalize drugs, which he says would end most drug-related crime.

IC: The arguments used for repeal of drug prohibition are the same used for methadone and bupe. You reduce the crime associated with illegal drug use, it's cost effective to just give them the drugs they want than to just talk to them and listen to them and they can become productive members of society. But you're still causing harm when you're jailing people for illegal drug use when you have a bupe substitution type program.

For now, that an opinion many disagree with. At roughly $2.50 for a 2 milligram pill compared to roughly 50 cents for a dose of methadone-- Baltimore's buprenorphine program is anything but cheap. But it's definitely cheaper than fixing the deeply entrenched social problems that so many people using drugs struggle to conquer.

I'm Sarah Richards, reporting in downtown Baltimore, for 88-1 WYPR.

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