Federal Proposal Could Expand Medication Assisted Opioid Addiction Treatment

The White House announced a proposal to expand opioid addiction treatment with buprenorphine

By:  Nicholas Rondinone
Hartford Courant

As part of broader federal efforts to address a heroin and opioid epidemic, the president's administration announced a proposed change Tuesday that could increase access to medication-assisted treatment for addiction.

President Barack Obama, at the National Rx Drug Abuse & Heroin Summit, said: "I think the public doesn't fully appreciate yet the scope of the problem."

The federal Department of Health and Human Services will propose a change that would allow qualified doctors to treat up to 200 patients with buprenorphine, up from the current 100-patient limit, the White House said.

Buprenorphine, which is marketed under trade names including Suboxone, is an FDA-approved treatment for opioid addiction with a low potential for abuse, the administration added.

U.S. Sen. Chris Murphy met with several people currently receiving Suboxone treatment Monday and was told of the difficulties finding an appropriate program after struggling with addiction.

"The president's announcement today is an important step toward stopping the devastating tidal wave of addiction and overdoses plaguing our nation. His actions will help tens of thousands of Americans get the life-saving treatment they need by doubling the number of patients a physician can treat with buprenorphine," said Murphy in a statement.

In a blog post announcing the proposed change, the White House said: "Existing evidence shows that this lifesaving, evidence-based treatment is under-utilized."

Patricia Rehmer, the president of Hartford Healthcare's Behavior Health Network, said the proposal would better allow them to meet the demand out there for medication-assisted treatment.

"We have been hoping for this. They've been talking about it for certainly the last six months, maybe the last year," she said, adding she's not sure there any providers who weren't hoping for this change.

Rehmer, who recently served as the commissioner of the Department of Mental Health and Addiction Services, said she heard that talks were calling for the patient limit to be increased to 500.

"Two hundred for me is also realistic for how many individuals one doctor can be responsible for," she said. "At this point 200 is better than 100."

Rehmer said the doctors working at Rushford have voiced support for an increase in the cap as well. As opioid and heroin-related deaths continue to increase in Connecticut, Hartford HealthCare has been working to increase access to medication-assisted treatment that included buprenorphine but have been confronted with this patient limit.

"The cap has been a significant barrier for the providers," Rehmer said. She said any increase in patients would be within their program that goes beyond just the prescription.

Dr. Vincent McClain, vice president of the state's chapter of the American Society of Addiction Medicine, said it was a reasonable accommodation for the access issue with prescribers hitting the 100-patient limit, but quality care must be maintained.

Susan Campoin, president of the Connecticut Association for Addiction Professionals, said the intentions behind the plan to expand access to buprenorphine comes from the right place, but treatment with buprenorphine needs to include therapy.

"They need to be treated by a licensed addiction specialist," Campion said. She said just receiving buprenorphine without the proper therapy was similar to getting rehab for a broken leg and only being given one crutch when you need two.

Without the additional therapy, Campion said, "there have been very sad and disappointing outcomes for people."

The change in cap was announced along with other steps including the availability of new grant funding, along with partnerships with some medical schools to require training on the matter.

U.S. Sen. Richard Blumenthal, D-Conn., said: "These steps are specific, positive measures — but only first steps against a public health hurricane sweeping the nation."