WASHINGTON, D.C. – With a record 2,110 fatal drug overdoses in Ohio in 2013 alone, U.S. Sen. Sherrod Brown called on the U.S. Department of Health and Human Services (HHS) to increase access to medication-assisted therapy (MAT) for patients struggling with opioid addiction. In a letter to HHS Secretary Sylvia Burwell, Brown and 12 of his Senate colleague urged her to raise the cap on the number of patients a physician can treat using MAT each year. 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.
“Too many communities in Ohio and across the country have been affected by the growing public health crisis caused by opioid use,” Brown said. “We’ve got a problem when it’s easier for Americans to get drugs than it is for them to get help to break their addiction. By ensuring that more health professionals can treat prescription drug abuse through proven medication-assisted therapy, we can save lives and strengthen our communities.”
Federal law currently limits the capacity for physicians and other health care 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.
Brown is a cosponsor of The Recovery Enhancement for Addiction Treatment (TREAT) Act, bipartisan legislation reintroduced in May that would remove the cap on the number of patients physicians with proven track records of success can treat using MAT. Additionally, the bill would allow nurse practitioners and physician assistants who are properly licensed, trained, and supervised to treat up to 100 patients per year.
The full letter can be found below:
August 7, 2015
The Honorable Sylvia M. Burwell
Secretary of Health and Human Services
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Secretary Burwell:
As you know, the United States is in the midst of a severe opioid abuse epidemic. In 2013 alone, approximately 1.9 million Americans met the diagnostic criteria for abuse or dependence on prescription pain relievers. We support the Department’s March announcement, which outlined a three-pronged approach to combat opioid abuse. We write today to urge you to use the full authority granted to the Department through the Drug Addiction Treatment Act of 2000 (P.L. 106-310) to increase access to medication-assisted therapy (MAT) for the treatment of opioid use disorders.
While effective medications to treat opioid use disorders exist, federal regulations continue to limit access to these treatments. These restrictions have created a huge disparity between those who can prescribe opioids and those who can prescribe treatments for opioid addiction. Only 10 percent of the 23 million Americans with addictions and substance use disorders receive any care in a given year.
Addiction experts agree that individuals suffering from an opioid use disorder need access to a broad range of treatments and services, including MAT, which typically involves a combination of medications and therapeutic supports to help people with opioid use disorders achieve recovery. Numerous studies have shown that MAT is cost effective, reduces drug use, disease rates, overdose risk and criminal activity among opioid addicted persons. For example, treatment with buprenorphine helps to reduce the transmission of HIV and hepatitis among drug users and the occurrence of high-risk injection practices.
Medications such as methadone and buprenorphine benefit patients by reducing the side effects of withdrawal and curbing cravings, thereby assisting patients to achieve abstinence from their substance abuse. Buprenorphine used alone or in combination with naloxone as an abuse deterrent formulation does not illicit a euphoric reaction in an opioid dependent patient and avoids the high risk of overdose associated with heroin and other opioids that are frequently misused and abused. Comprehensive MAT programs that include measures such as drug testing, the provision of behavioral counseling and other social services, implementation of anti-diversion measures, use of Prescription Drug Monitoring Programs, and reporting of drug use and treatment outcome measures help to ensure that quality care is provided to patients, while also reducing the risk of buprenorphine diversion.
Despite the effectiveness of MAT as one of the tools available to treat opioid addiction, there is significant under-treatment with this proven therapy. According to the National Survey on Drug Use and Health, of the 2.5 million Americans 12 years of age or older who abused or were dependent on opioids in 2012, fewer than one million received MAT.
Use of buprenorphine is highly controlled. In order to prescribe buprenorphine therapy, physicians must take and pass an eight-hour course and meet other qualifications, and then apply for a special waiver. The Drug Addiction Treatment Act (DATA) was enacted to allow, for the first time, opioid addiction treatment in a primary care setting. This law arbitrarily capped the number of addicted patients a physician can treat at any one time to 30 through the first year and, if requested and certified, permits expansion to 100 patients thereafter. As an acknowledgement that the cap was set without a full understanding of what market use and application could be, the statute grants you as HHS Secretary direct authority to raise the cap. Lifting the cap under specific circumstances or other measures to increase access would enable physicians to treat more patients with these highly effective drugs and improve and increase access to quality and comprehensive opioid treatment programs. In addition, expanding the ability of other trained health professionals such as nurse practitioners and physician’s assistants to practice as DATA providers merits consideration.
We view Administrative action to raise the current prescriber caps for providers in the appropriate practice environment for highly effective MAT medications such as buprenorphine therapy as an important part of larger collaborative efforts between the Congress and the Administration to address substance use disorders.