| Maine delegation urges HHS to waive 30-patient limit for doctors who treat
opioid addictions, citing an “ongoing crisis in our state”
Maine has been struggling with providing a solution to its disproportionately high
opioid addiction rate. On December 8, 2005, Senator Susan Colins and others sent
a plea to the Administrator of the HHS/SAMHSA asking that Maine be exempt
from the 30-patient restriction for prescribers of Suboxone®.
Under a provision of the DATA2000 law, The DHHS can exercise its authority to
exempt already certified physicians from the 30-patient treatment limitation. Maine
is asking for this exemption for all certified addiction medicine specialists. The letter
goes on to point out that:
There has not been a single documented overdose death in the U.S. since the
drug’s introduction (3 years ago).
Without this exemption Maine would have to import 667 new certified/
licensed/trained physicians to be able to prescribe enough Suboxone to
meet the existing need of untreated patients in the State.
Maine’s methadone programs are at capacity, as are the buprenorphineprescribing
The letter goes on to point out the inconsistencies of the FDA to continue to
approve potent new opioid analgesics without placing similar limits on prescribers.
A strong hydromorphine analgesic was approved in January 2005 without any
patient limitations. This drug, unlike Suboxone, had a very high abuse potential.
In July of 2005 It was abruptly withdrawn from the market because of evidence
that the pills could be fatal to patients who take them with alcohol. Suboxone has
proven to be extremely safe even among a population prone to misuse.
There is much and growing support in other states and medical organizations for
removal of this needless arbitrary rationing of healthcare. NAABT supports removal
of the limit.
by Timothy Lepak
|Only 20% of the 5.5 million people suffering from opioid addiction receive
treatment each year. The Drug Addiction Treatment Act (DATA) 2000 made
it possible for these patients to
be treated in the privacy of their
doctor’s office. On
October 8, 2002 the FDA approved
Suboxone® and Subutex®, the first, and to
date only, medications available for this new treatment modality.
Despite over 7,000 physicians trained to prescribe Suboxone many patients and
their advocates are frustrated by the process of trying to find a physician who will
treat them. Why? Although there are many difficulties to obtaining treatment
another solution has been, Nurse Practitioners and Physician Assistants.
DATA 2000 states only “physicians” may obtain a waiver to prescribe. This
excludes an entire pool of professional prescribers, known as Nurse Practitioners
and Physician’s Assistants. Many nurse practitioners specialize in treating addictive
disorders and psychiatric illnesses. NP’s have prescribing rights to other Schedule II
& III medications (prescribing limitations vary from state to state). In many states
NP’s are legally able to prescribe the very narcotics that contribute to addiction
such as hydrocodone. It took a written and intentional exclusion to prevent NP’s
from being able to become certified to treat with Suboxone.
The lives of millions of patients are at risk, laws have been enacted to save lives,
yet ironically this exclusion puts yet another roadblock in the path of the patient
who is trying to get help.
NAABT and others around the country are beginning to advocate for amending
the law so that NP’s can prescribe and fully treat their own patients and others
who need help. This would increase significantly the pool of certified providers
available to patients who want help.
by Kathleen Gargano
naabt.org continues to evolve. The
public access discussion board has
evolved into a virtual support group.
Members continue to offer advice,
share experiences, discuss support
options, and help each other cope
It is also a place for
loved ones to ask
questions to better
and treatments. When
a patient is beginning
treatment it is a place
to go where they can
retain their anonymity
and still “talk” to
someone with similar experiences. Creating realistic patient expectations
alleviates some of the anxiety of
beginning a new medication.
Comments about last
On the article about precipitated
withdrawal we want to add that
the biggest misconception with
precipitated withdrawal is that the
Naloxone contained in Suboxone is
the cause. The Naloxone can only
precipitate withdrawal if injected.
Buprenorphine itself precipitates
withdrawal under the conditions
outlined in last month’s newsletter.
Therefore Subutex is as likely to
precipitate a withdrawal as is
Suboxone when administered
• Pregnancy and Buprenorphine
• Results of Patient Waiting List Pilot
|All NAABT literature is available on the
naabt.org Literature page as PDF files
of literature for you to download and
view or print for your convenience. For multiple copies of NAABT
Literature, please email your request
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