Problems being caused by addiction to pain pills and heroin continue to generate interest in changing laws
to facilitate more effective treatment. Two weeks ago I had the opportunity to conduct a briefing, on behalf of the American Society of Addiction Medicine, for staff of the U.S. Senate committee that oversees health issues. In their effort to educate themselves about the relevant issues, the committee staff had asked to hear from practicing clinicians such as myself. They are a bright and interested group who listened attentively and followed up with questions.
One of the issues currently being considered regarding addiction to pain pills is making buprenorphine more accessible to patients. In 2000, when legislation allowing buprenorphine to be used in this country was passed, concern about its potential misuse led to a restriction on the number of patients that a physician could treat to 30. Because relatively few physicians were willing to work with opioid addicted people, this limitation was recognized as being unrealistic, and the limit was raised a few years later to 100 patients per physician.
As the effectiveness of buprenorphine has been recognized and the number of patients taking it for extended periods of time has increased, more patients have had difficulty finding physicians who have not filled their quotas. As a result, Senator Edward J. Markey (D-Mass.) submitted a bill that would increase the number of patients that a physician would be allowed to treat. It would also extend prescriptive privileges to nurse practitioners and physicians assistants, who, until now, have not been allowed to prescribe buprenorphine despite its relative safety compared to other medications.
The old saying “The devil is in the details” is relevant here and important ones to be decided are whether the limit should be increased or eliminated entirely and what expertise should be required of the prescriber. When laws are changed, many conflicting forces come into play. My hope, and that of other clinicians, is that the opinions of those who treat these patients will be incorporated into the final decisions, which is why I was so glad to have to opportunity to speak with the Senate committee staff.
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