The Obama administration on Wednesday announced a policy change that will make it easier for doctors to prescribe a medication that is increasingly used to help opioid and heroin addicts manage and potentially eliminate their addiction.
Prior to the policy change, doctors were limited to prescribing buprenorphine, also known as Suboxone, to 100 patients. The Department of Health and Human Services is now increasing that cap to 275 patients per doctor, effective in August, though doctors will have to apply to be subject to the higher cap.
Doctors are currently required to be certified by the
Substance Abuse and Mental Health Services Administration to prescribe buprenorphine.
The policy comes after increasing political pressure to ramp up the government’s response to increases in abuse and overdose of opioid drugs such as oxycodone, hydrocodone, and heroin. Drug-poisoning deaths outnumbered traffic deaths and reached a new high in 2014 — totaling 47,055, according to a January report from the US Centres for Disease Control and Prevention (CDC).
Drug-policy reform advocates have been clamoring for a change to caps on buprenorphine prescribing for years, They say the current system prevents addicts from receiving treatment that could save their lives. Buprenorphine has been criticised by some because it has been abused by some users to get high.
“It’s meaningful progress,” Daniel Raymond, the policy director of the Harm Reduction Coalition, a national advocacy group, told Business Insider of the change. “We would love it to go higher, but we understand that, in a crisis, any movement is a movement in the right direction.”
Baltimore Health Commissioner Dr. Leana Wen, however, said she believes the changes to the prescriber cap do not go far enough. Wen told The Baltimore Sun that she believes the cap needs to be eliminated completely, saying the government’s policy towards buprenorphine is “based on stigma and not science.”
Federal officials estimate that between 10,000 and 70,000 new people may be able to obtain access to buprenorphine in the first year of the change. Approximately 650,000 patients received buprenorphine in 2014, according to the federal government.
A 2015 Huffington Post report found that multiple states were having difficulties providing access to buprenorphine due to a combination of the prescriber caps and a lack of doctors who were willing to get certified to provide the treatment. In some cases, doctors with certifications simply refused to provide the treatment.
Many doctors are not comfortable prescribing buprenorphine due to fears about treating too many addicts and the potential issues that might arise.
“Providers are not comfortable doing it. … It immediately raises red flags,” Dr. Aleksandra Zgierska, a family medicine doctor at University of Wisconsin Health, told The Chippewa Herald.
The Huffington Post found that one clinic in Ohio had a waiting list of 500 patients. And according to state data on Kentucky, only 18% of the 470 buprenorphine-certified doctors filled out 80% of the prescriptions. In many cases, addicts overdose or even die while sitting on years-long waiting lists for buprenorphine treatment programs.
Raymond, of the Harm Reduction Coalition, said he believes that the policy change is a positive step — but that it will only fix part of the issue.
While the change may alleviate some issues with individual doctors, physician assistants and nurse practitioners are not allowed to prescribe buprenorphine at all. Changing that policy, which would require the approval of Congress, could have a greater effect on improving buprenorphine access, Raymond said.
The next battle will be about ensuring that there is funding and infrastructure to support medication-assisted treatment programs, as well as making sure that those in need of the treatment are provided access, according to Raymond.
The new policy changes “will affect the supply of treatment, but we need to make sure the demand for treatment is connected to that supply efficiently and effectively,” Raymond said.
House and Senate members met on Wednesday to try to complete the Comprehensive Addiction and Recovery Act (CARA), a legislative package aimed at tackling the opioid crisis. The package, if passed, would allow nurse practitioners and physician assistants to prescribe buprenorphine, as well expand the use of naloxone, an overdose-reversal drug, and push the focus of treatment toward newer evidence-based treatments.
Though Raymond believes that the legislation is, like the rule change, a step in the right direction, the real test will come in how much funding is provided by the government.
The Obama administration asked Congress for $1.1 billion in funding for treatment earlier this year. Democrats on the conference committee have since requested $920 million, but CARA contains no funding for the programs. Some Democrats on the panel said in a letter on Tuesday that they will not support CARA without funding.
Republicans have argued that funding for such programs should come through Congress’ yearly appropriations process.
According to The Huffington Post:
“[T]he federal government spent $220 million on discretionary opioid spending in 2015 and has allocated $321 million for 2016. The White House requested $404.5 million in 2017, and the Senate has proposed $471.5 million.”
The $1.1 billion proposed by the administration — and the $920 million sought by Democrats — would be in addition to those figures and would be directed specifically at medication-assisted treatments like buprenorphine.
Raymond said he worried that leaving funding up to the appropriations process would result in funding not arriving until next year because of increased gridlock resulting during this year’s elections.
Said Raymond: “We have to make sure the system works better for everyone. It’s going to take more than policy, but additional funding.”
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