Last week I attended the ASAM State of the Art in Addiction Medicine Conference in Washington and one of the speakers was Gil Kerlikowske director of the ONDCP
(Office of National Drug Control Policy). After his talk on the
successes of the white house’s program, and the promise of the “2011 National drug control strategy”
he was asked about elimination of the 30/100 patient limit plaguing
buprenorphine providers, their patients and their loved ones. This was
the only question of the conference met with spontaneous applause. Mr.
Kerlikowske was caught by surprise and admitted he was completely
uninformed about a limit, and gave no indication that he even knew
anything about the legislation pertaining to buprenorphine. This is
alarming in light of the new CDC report
showing 40 people a day die from prescription opioid overdose, 15,000 a
year (in 2008). Meanwhile, patients are being denied lifesaving
treatment due to effective rationing of care through government imposed
patient caps. A search of the ONDCP website shows ZERO results for a
“Suboxone” or “Subutex” and only two mentions of “buprenorphine” which
were only incidental mentions and not about buprenorphine.
Here’s what the National drug control strategy claims to be about; From the White House ONDCP website: 2011 National Drug Control Strategy
…Building on the Obama Administration's inaugural Strategy, released last year, the 2011 National Drug Control Strategy serves as the Nation's blueprint for reducing drug use and its consequences. Continuing our collaborative, balanced, and science-based approach, the 2011 National Drug Control Strategy emphasizes drug prevention and early intervention programs in healthcare settings, diverting non-violent drug offenders into treatment instead of jail, funding more scientific research on drug use, expanding access to substance abuse treatment, and supporting those in recovery….
Yet, no mention of the most significant development in the
last 50 years for the treatment of opioid addiction anywhere on the
site, and apparently no awareness of the significant limits to access of
this important substance abuse treatment, buprenorphine. How can expanding access to substance abuse treatment
be the strategy while completely omitting the most effective treatment?
How could someone whose full time job is related to substance abuse
treatments be unaware of the significant limitations to access facing
people seeking buprenorphine treatment? I’m amazed and disappointed,
especially when the limit could be removed tomorrow with a signature
from the Secretary of Health and Human Services. But instead another 40
people will die tomorrow from opioid overdose, some of whom would have
been saved if they had access to buprenorphine treatment.
NAABT.org is collecting letters and email testimonials from people affected by the government imposed limit on saving lives. If limited access to buprenorphine treatment has impacted you please write to us and tell us your story. The letters will be made public, and presented to Congress and the administration, so conceal your identity if you want to maintain anonymity. Go to https://www.naabt.org/contact_us.cfm to submit or mail your testimonial. We can end this obstacle to care, but we need your help.
Dec 13, 2011 at 10:51 AM I was the second person to comment on the dangers and risks of the 100-patient limit after the applause that was given to the first person to comment after Mr. Kerlikowske's talk. He invited us to leave our names with his assistant in the back of the room and stated that he would be contacting us. It is now about six weeks after the conference, and I have yet to hear one word from him or his office. I am disappointed with this apparent head-in-the-sand approach. It seems that if it's not prevention or interdiction, there's no room for it in their policy, yet treatment and demand reduction are the only means that have shown success in reducing drug use among addicts.
Thanks for keeping this topic active and fresh.
Dec 13, 2011 at 11:26 AM I sent an email to the ONDCP immediately after the ASAM meeting and received this email 11/17/2011-
Dear Mr. Lepak:
Thank you for your recent email regarding quota limitations for certain medication-assisted therapies.
In response to this question, ONDCP will be discussing this issue with the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA, under the auspices of the Secretary of Health and Human Services, is the responsible Federal oversight agency. Once further information is gained, we will be in touch regarding the issue. We appreciate the urgency of the issue and that it was raised at the meeting.
Regina M. LaBelle
Deputy Chief of Staff for Policy
Office of National Drug Control Policy
Executive Office of the President
Dec 13, 2011 at 5:08 PM No wonder this country is going down the toilet. NO WONDER, this is the most pathetic stupid ignorant thing I have yet to read to date about our nations "progress".
Mar 7, 2012 at 7:42 AM yes I know... there is waiting list to get treatment
we really need to eliminate 30/100 limit.
i like to know the reason behind
Mar 11, 2012 at 10:43 AM I ran into Gil Kerlikowske at one of those coffee places on Capitol Hill and I could not resist asking him if the government was serious in addressing the drug problems of the country and he was polite enough to give me a brief answer. "Yes, certainly." He ran off in a rush with his coffee in hand.
Feb 11, 2014 at 11:55 AM He is probably also unaware the DATA act proscribes prescription of any Bup product by NP'S and PA's.
Duh, what was that about? This is the only medication I cannot legally prescribe but write up the Rx and leave for weekly signature by physician. Like I did in the 1980's before NYS registered NP'S and i get a DEA license. But I can write all the oxys I want (but per the NYS I-stop law, must now document having looked up patient for other controlled Rx's prescribed by others currently and in prior months).
Hence, the need for TX has never been greater, as people are suddenly cut off oxys and switch to heroin. The od rate is .....makes me ill....unnecessarily rising monthly.
Give me one cogent reason to exclude these thousands of potential providers, who Have More experience in clinical practice with this "population* percentage wise than do most physicians.
I left the job but was in charge of admitting pts, initiating suboxone TX (from stock) and providing all medical care at a MSOAD ? ("medically" supervised outpatient addiction TX service) in a men's shelter in NYC 2007-8.