Bill Would Remove Federal Limitations on Treatment Restrictions Which Block Access to Treatment for Those Addicted to Opioids
COLUMBUS, OH — With 1,914 Ohioans dying from drug overdoses in 2012, U.S. Sen. Sherrod Brown (D-OH) on Tuesday visited the Alcohol, Drug, and Mental Health (ADAMH) Board of Franklin County to announce a plan to help fight the scourge of opiate abuse wreaking havoc throughout Ohio. Opioid overdose, including death from prescription pain relievers and heroin, has increased dramatically in the United States. Drug abuse now costs more American lives than car accidents and one of the culprits is the lack of treatment available to people who are opioid dependent or addicted. Brown will announce his support for The Recovery Enhancement for Addiction Treatment Act (TREAT Act), legislation that would change U.S. law to enable more health care providers to treat larger numbers of patients struggling with addiction.
“Americans all across the country have been affected by the growing public health crisis caused by opioid use,” Brown said. “This is a complex scourge that requires a multi-pronged solution. We’ve got a problem when it’s easier for Americans to get heroin than it is for them to get help to break their addiction. That is why we must give patients greater access to drug addiction treatment in the outpatient setting. The TREAT Act would accomplish this by enabling more health care providers to treat larger numbers of patients struggling with addiction to opioids such as oxycodone and heroin. This will help save lives while simultaneously saving our hospital system money and reducing drug-related crimes.”
Opioid addiction is a chronic disease that, when left untreated, places a large burden on the healthcare system. Deaths from opioid overdoses in the United States has increased by more than five times since 1980. In Ohio alone, a record 1,914 citizens, or five people per day, died from unintentional drug-overdose in 2012. Two thirds of these overdoses involved opioids. Each year, about 475,000 emergency room visits are attributable to the misuse and abuse of opioid pain killers across the U.S.
Federal law currently limits the capacity for providers to treat opioid abuse. Under current law, physicians must meet specific conditions and apply for a special waiver in order to be authorized to prescribe certain opioid addiction medicines, like buprenorphine. Further, physicians are legally disallowed from treating more than 30 patients during their first year with a waiver, and are restricted to treating only 100 patients per year afterwards. This has led to long waitlists for treatment and has made it more difficult for patients to receive the treatment they need.
As a result, of the approximately 2.5 million Americans who abused or were dependent on opioids in 2012, fewer than 40 percent received medication-assisted therapy for their condition. To help solve this problem, the TREAT Act would increase the number of patients that providers are allowed to treat in an outpatient setting; and, for the first time, allow qualified nurse practitioners and physician assistants to treat addicted patients. Specifically, this legislation would:
Increase the number of patients providers are initially allowed to treat from 30 patients to 100 patients per year during their first year of certification for treatment.
Allow physicians, after one year, to request removal of the limit on the number of patients they can treat. To be eligible:
Physicians must be substance abuse treatment specialists, as recognized by specific board or society certifications, or
Non-specialist physicians must complete approved training and practice in a “qualified practice setting.”
“Qualified practice settings” are named in the legislation and include clinical settings that have defined oversight, performance metrics, or quality review, or that are part of systems serving populations with high need.
Allow certain nurse practitioners and physician assistants to treat up to 100 patients per year, provided they:
Are licensed in a state that already allows them to prescribe controlled substances (like Ohio),
Complete approved training on opioid addiction treatment, and
Are supervised by a physician who is approved to prescribe opioid addiction medicine, such as buprenorphine.
Require the Government Accountability Office (GAO) to examine changes in treatment availability and utilization; quality of treatment programs; integration with routine healthcare services; diversion; impact on state level policies and legislation; and use of nurse practitioner and physician assistant prescribers.
Joining Brown to urge passage of this legislation was ADAMH Board of Franklin County CEO David Royer and Dr. Mark Piacentini, a Marion County physician on the front line of treating people with opiate and prescription drug dependence and addiction in central Ohio. Brown was also joined by Eric Carrico, a Franklin County resident who struggled with prescription drug and heroin use for 10 years before enrolling in a treatment program through Maryhaven in Columbus.
Brown has led the fight to help prevent and crack down on prescription drug abuse. His work includes efforts to shutter pill mills, monitor physicians whose prescribing patterns are outside the norm, and end the practices of “doctor shopping” and “pharmacy hopping.” Brown is currently working on a bipartisan bill that will increase monitoring of and corrective action on prescription patterns on the part of doctors, pharmacies, and patients. It would include a Medicare lock-in program for patients whose prescription-filling patterns suggest drug over-use. Lock-ins limit high-risk patients from visiting multiple doctors and pharmacies to obtain and fill prescriptions. In 2012, Brown appeared before a Senate committee to discuss Ohio’s prescription drug epidemic and to call for the implementation of a Federal Medicaid Lock-In program. He also joined a group of bipartisan senators to introduce legislation to reauthorize the National All Schedules Prescription Electronic Drug Reporting (NASPER) Act, a prescription drug monitoring program critical to combating the abuse of prescription drugs.
Sen. Brown has also joined his colleagues in introducing legislation that would prevent teenagers from gaining access to discarded prescription drugs by permitting individuals and long-term care facilities to deliver unused drugs for safe disposal and by expanding drug “take-back” programs. And in 2013, he wrote a letter to the Centers for Medicare and Medicaid Services (CMS) Deputy Administrator and Director Jonathan Blum, urging better oversight over the prevention of prescription fraud and abuse within the Medicare Part D program.