Building on efforts to combat America’s growing epidemic of opioid addiction and overdoses, the Obama administration has finalized plans to lift the federally mandated cap on the number of patients to whom a physician can prescribe buprenorphine — the medication that experts in the field tout as an effective tool to treat addiction to heroin and prescription painkillers.
For over a decade, physicians who receive a federal waiver have been able to prescribe buprenorphine for up to 30 patients at a time in their first year, and up to 100 patients in the following years. However, the lack of doctors providing buprenorphine in many parts of the country — along with the dramatic spike in heroin use — has led to long waiting lists for those seeking treatment, with a growing number dying of an overdose during that wait.
As part of their push for an increase in access to medication-assisted treatment — using medication such as buprenorphine or methadone in combination with behavioral therapy and counseling — the U.S. Department of Health and Human Services announced a proposal in March to increase the patient cap to 200 by the end of this year. Hearing input from providers and advocates that such a cap would still be too low, HHS announced Wednesday that their final rule will lift the cap to 275 patients and go into effect on Aug. 5.
The HHS announcement was applauded by the American Society of Addiction Medicine, which has long touted decades of research showing buprenorphine as a very effective way to treat opioid addiction and advocated for barriers to its access being lifted.
“For too long, addiction specialists like me have had to turn patients in need away from treatment that might save their lives, not because we don’t have the expertise or capacity to treat them, but because of an arbitrary federal limit,” said Dr. Jeffrey Goldsmith, president of ASAM. “It has been heartbreaking to tell patients and their families that my hands are tied, and to see them continue to suffer from a treatable disease. ASAM physicians are grateful that we won’t have to say that quite as often anymore.”
Dr. Molly Rutherford — a buprenorphine provider in Oldham County and president of the Kentucky chapter of ASAM — tells IL that she often has a waiting list as high as 30 patients, as people from all over the state call in and seek treatment. Last month, Rutherford’s office contacted someone on the waiting list to inform her of an opening, only to learn she had died of an overdose — a tragedy other providers she knows in Kentucky have experienced recently, as well.
Sen. Rand Paul has co-sponsored legislation to lift the patient cap even further to 500 and gave rare praise to the Obama administration for their move Wednesday, calling it “an important first step to unshackling and better empowering physicians to confront the growing epidemic of opioid addiction.”
Paul told IL in June that he was hopeful this aspect of his bill would be incorporated by a joint conference committee of the House and Senate working to hammer out a wide-ranging bill combining legislation passed in both chambers to fight the opioid epidemic. However, the Huffington Post reports that the committee’s bill does not raise the cap any further, though it explicitly allows HHS to lift the cap on its own.
The committee’s bill takes several measures to increase access to medication-assisted treatment — far less available than traditional abstinence-only 12-steps treatment, which is often hostile to buprenorphine because it is an opioid with the potential for abuse — but could be bogged down over an appropriations dispute. The White House, congressional Democrats and several advocacy groups say roughly $1 billion must be appropriated by Congress in order for the legislation to even put a dent in the heroin epidemic, but deficit-hawk Republicans have balked at that figure.
In addition to lifting the buprenorphine cap, HHS also announced Wednesday it is proposing to alter the effect that patient satisfaction surveys have on Medicare and Medicaid payments to hospitals and providers. Many doctors say they feel pressure to prescribe opioids to treat pain in patients because they are partially scored based on these surveys, thus creating a financial or professional incentive to give patients what they want even when it isn’t necessary. The HHS proposal calls for removing pain management questions from the hospital payment scoring calculation to ensure it does not affect the level of payment hospitals receive.