December 21st, 2015


Government responses to the upsurge in addiction to opioid medication continue to appear, but the question as to how much of a difference they will make has not yet been answered. Two promising ones are among the most recent.

One of Maryland Governor Larry Hogan’s first acts after taking office was to appoint a task force to study this problem. The final report of the Heroin & Opioid Emergency Task Force was released December 1 and is very comprehensive. As a clinician, I was pleased to see that the report starts off by recommending “expanding access to treatment” and “enhancing the quality of care.” Although the evidence is that addicted individuals can do well once they enter treatment, most addicts do not get treatment and some that do get it do not get the best of care.

I was further encouraged that the top recommendation within the expanding treatment section was to expand access to buprenorphine. I, along with most addiction professionals, am impressed with the improved treatment outcomes that have occurred since this medication became available in 2003. At the same time, this opinion is not universal. Some clinicians, in the more traditional wing of our field, as well as many members of Narcotics Anonymous, think that the net effect of buprenorphine has been negative. In addition, I disagree with the manner in which some physicians use the medication. They provide supervision that is too loose or does not require participation in psychosocial treatment.

The buprenorphine issue is relevant to a second recent government response, President Obama’s call to the medical profession to help address the opioid addiction problem. His Health and Human Services Secretary, Sylvia Burwell, has indicated that one of the paths she may use in this effort relates to buprenorphine. Although she has not been specific, there is a likelihood that this might involve increasing the limit on the number of patients for which physicians may prescribe that medication.

Allowing buprenorphine to be used in this country involved a complex political negotiation that resulted in some unique features. One is that it is the only medication which has a limit on the number of patients that a physician can treat. The initial limit was 30 patients, which was clearly too restrictive. I actively advocated to get this limit raised to 100 patients, and I am supportive of further relaxation of the limit, but I am concerned about the way in which this will be accomplished. Thoughtful, detailed proposals have been put forward by the American Psychiatric Association and the American Society of Addiction Medicine.

When matters such as these are settled, however, in a political arena that brings together many conflicting interests, including investor-driven commercial entities, the results are not always to my liking, which gets back to the title and opening of this piece. Stay tuned.



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