An article in the September 2 issue reported on legislation that Congress
had approved and the president had signed eliminating the restriction of 30
patients that group practices can treat at one time with buprenorphine. While
this is welcome news, and doctors and patients alike appreciate the increased
access to this remarkable new treatment option for opiate-dependent patients,
it must be noted that there remains the 30-patient limit on individual doctors
who prescribe this medication.
It is estimated that there are somewhere between 4,000 to 5,000 doctors
actively prescribing buprenorphine, and even if all of them are treating 30
patients each (which they are not), this means that at most 150,000 patients
are able to receive this treatment. It is more likely that between 50,000 to
75,000 patients are getting this treatment, but more than 1 million people are
estimated to be opiate dependent in the United States (only a small number of
these are receiving the other drug option, methadone).
I have been at my limit of 30 patients for more than 18 months and turn
away at least five potential new patients each week. I also had a patient die
from a heroin overdose while waiting for a treatment slot to open.
The experience in South Jersey and other places throughout the country is
that there are clearly not enough buprenorphine-certified doctors willing and
interested in treating these patients to even come close to meeting the need.
Furthermore, it is ridiculous that the physicians who have the most experience
with this treatment, those who offer the treatment the most and at the limit
of 30 patients, are not able to utilize their expertise to treat more
patients. In no other medical discipline are the most experienced physicians
limited in treating patients. Would anybody go to a heart surgeon who only
operated on 30 patients?
It is imperative that APA and the American Society of Addiction Medicine
and other organizations work with congressional leaders to eliminate the
30-patient limit completely for all prescribers. I cannot think of any better
way to address the drug problem than to increase access to treatment for all
willing and interested patients. This approach to demand reduction will not
even increase costs to the government, as patients will either use insurance
or pay for it themselves. Buprenorphine, as a partial opiate agonist,
essentially cannot be abused and has practically no euphoric effect. We must
increase treatment availability—patients are dying needlessly.
We agree with Dr. Shore and now hope to address the individual limit.
The effort to see the group bill become law took the better part of a year
and a half of dedicated work by our lead sponsors: Rep. Souder and Sens.
Hatch, Grassley, Biden, Durbin, and Clinton. They—and the psychiatrists,
other physicians and health professionals, and organizations that lobbied for
the bill—have our gratitude.
Because of the concern that lifting the individual limit would create a
perception of potential drug diversion and abuse, our sponsors declined to
simultaneously lift the group and individual limits.