June 09, 2016
Area(s) of Interest: Advocacy Drug Prescribing/Dispensing Patient Care
The Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the U.S. Department of Health and Human Services, published a proposed rule that would expand access to buprenorphine, one of three medications currently approved by the Food and Drug Administration (FDA) for medication-assisted treatment of opioid use disorder. The proposed rule would increase the limit on the number of patients that qualified physicians can treat with buprenorphine, increasing access to live-saving addiction treatment services.
The California Medical Association (CMA) supports the administration in its efforts to increase access to much-needed medication-assisted treatment for opioid use disorders, recently submitting comments on the proposed rule.
Currently, physicians must obtain a Drug Addiction Treatment Act of 2000 (DATA 2000) waiver from SAMHSA if they wish to prescribe buprenorphine for treatment of opioid use disorder. Initially, they may treat up to 30 patients at a time; after one year they may file a request to treat up to 100 patients at a time. The proposed regulation would raise the existing patient limit of 100 patients to allow qualified practitioners to treat up to 200 patients.
Across the country, many people suffering from opioid use disorder are unable to access medication-assisted treatment for their condition due to a lack of nearby physicians with waivers to prescribe buprenorphine. And, California is no different. In 2013, there were only 1,460 waivered physicians actively prescribing buprenorphine in California, which amounts to approximately 3.9 physicians per 100,000 people, particularly impacting rural and underserved areas in the state.
With more than 2.2 million people nationwide last year who met the diagnostic criteria for an opioid use disorder, increasing appropriate access to live-saving addiction treatment services is one component of a balanced approach to addressing rising opioid-related morbidity and mortality rates. Treatment of opioid use disorder with opioid maintenance therapies has been shown to be cost effective, safe and successful when used appropriately.
Despite the known effectiveness of this treatment, physicians have been slow to prescribe buprenorphine due to many possible barriers and concerns, including third-party reimbursement and documentation, stigma, lack of adequate training and education, and a lack of community behavioral supports. While CMA thinks increasing the limit to 200 patients from the cap of 100 patients is a strong step in the right direction, more needs to be done to address the complicated issues related to prescription opioid misuse and overdose.
The California Society of Addiction Medicine offers a live educational course for physicians that addresses the challenges of managing patients on buprenorphine in different practice settings and also provides continuing medical education credits. The workshop is designed for those with a buprenorphine waiver who are not yet fully utilizing it in their practice.