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Born of fear that local
doctor’s offices might turn into “pill
mills”, physicians were
limited to (treating with Schedule
III, IV or V medications) 30 opioid-addicted
patients under their care at any one
time. (DATA-2000) Leaving the rest
of the
patients in need in the community,
untreated, was somehow seen as a logical
solution. It is now clear that these
fears were unfounded and this rationing
of care
is only creating another obstacle for
those in need of this life-saving treatment.
Senators Carl Levin
(D-Michigan) and Orrin Hatch (R-Utah)
held a symposium
and press conference August 3, 2006,
in the Russell Senate Office Building.
The purpose was to bring attention
to the success of buprenorphine since
its
introduction nearly four years ago.
The leading experts in the country
were in
attendance. “It can’t be
a secret weapon,” said Levin. “It’s
got to be known. It’s
got to be available.”
Bill S.2560 was introduced
in the Senate 4/6/2006 that if passed
would eliminate
the 30 patient limit for physicians
who have had their waiver for more
than one
year. It is part of a larger bill to
reauthorize funding for the Office
of National Drug
Control Policy (ONDCP) Levin said he
hopes for a September vote. For more
details see: http://www.naabt.org/news.cfm
NAABT has an online petition
in support of the removal of the 30-patient
limit.
Just click on the above banner to go
to the petition page. If you have your
own
website you may download the above
banner for inclusion on your site.
This will
allow your visitors an easy way to
add their support. For instructions
see:
http://www.naabt.org/petition_banners.cfm
To
check on the status of the 30 limit
see:
http://www.naabt.org/30_patient_limit.cfm
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Buprenorphine Study Published in the
New England Journal
of Medicine: Counseling and Treatment
Outcomes Evaluated
Buprenorphine treatment
is proving to be an effective solution
to a shortage of
treatment options for opioid addicted
patients. Certified physicians (including
those in
primary care and office-based practices)
are now able to treat opioid addicted
patients
in the privacy of their offices, giving
the patients alternatives over Methadone
and brief
detoxification programs.
Literature
indicates that counseling is a useful
component for effective treatment.1 Some
questions remain and include: What
type of counseling? How much counseling?
Where can counseling be delivered when
a Primary Care doctor prescribes
buprenorphine but isn’t able
to offer counseling from his or her
practice?
A study conducted at Yale
and recently published in the New England
Journal of
Medicine by Dr David Fiellin, et al
(NEJM August 27, 2006) attempts to
answer some of
these questions.
166 patients were randomly assigned
to one of three groups and treated
for six
months with a medically based counseling
model that incorporated aspects of
Motivational Enhancement Therapy, 12-step
facilitation and Cognitive Behavioral
Therapy. The counseling was performed
by nurses who had no prior experience
in
providing drug counseling but received
training and supervision prior to and
during the
study. All patients received daily
buprenorphine/naloxone at an average
dose of 17 mgs
per day. The variable was the amount
of counseling each patient received
and number
of weekly visits to the Primary Care
Center that patients made. Some received
20
minutes of nurse counseling weekly;
others received 45 minutes per week.
Some
patients came to the clinic for medication
once a week; others came to receive
medication thrice weekly. All patients
met with a physician monthly for approximately
20 minutes. Patient outcomes were favorable
and similar in all three groups. In
fact,
the results showed a slight advantage,
although statistically insignificant,
for the 20
minute counseling sessions and once
per week clinic visits with 44% opioid
negative
urines vs. 40% in each of the other
two groups.2
– Kathleen Gargano, RN
1Fiellin, Kleber, Trumble-Hejduk,
McLellan, Kosten. Journal of Substance
Abuse Treatment. 27(2):153-9,
2004 Sep.
2From the Departments of Internal
Medicine (D.A.F., L.E.S., P.G.O.) and
Psychiatry (M.V.P., M.C.C., B.A.M.,
R.S.S.), Yale University School of
Medicine, New Haven, Conn.
Fiellin, et al (NEJM August 27, 2006) |
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| The
NAABT Patient Physician Matching
System has been tested in a few select
cities and has successfully connected
96%
of the patients with a physician. One
unexpected result was that the system
has provided a non-intimidating way for
patients to reach out for help. This
will
possibly drive patients to treatment
sooner. Since patients can apply 24-7,
they can effectively reach out for help
as
soon as they first feel they need help.
We
have expanded the service areas to
include: ME, NH, VT, MA, RI, CT, MD,
GA
and western PA. There have been a few
cases where patients have been contacted
by physicians with hours of registration,
and some have been offered an
appointment the same day. National
Launch will be sometime in September.
What is the National Patient/Physician
Matching System? |
 |
From about mid
April of this year patients with fentanyl
overdoses began to show up in ERs across
the country. The powerful narcotic
was being used in conjunction with
heroin. With many recent arrests it
seems to be on the decline.
>
Fentanyl Summary Sheet |
 |
The NAABT
Discussion Board now has
over 1,260 members who have posted
over 21,500 posts, over the last 12
months. The main educational site
receives an average of 1,500 visitors
a
day. Although the discussion board is
not a substitute for counseling, many
have reported benefit from the
anonymous peer based forum.
We have added
to our Literature
Page –
consolidating some of the pertinent
material available on the web.
The
Physician Locator (Doctor/Patient
button) sorts physicians by distance
in
geographic proximity, regardless of
city,
town, county, or state borders.
Click
here to try it for yourself.
Current Newsletters are
available at the naabt.org
homepage. Past editions are available
on our Literature
page, under Other
Literature. |
Disclosure: NAABT, Inc. has accepted funding
from Reckitt Benckiser (Richmond, VA,
pharmaceutical company that manufactures
buprenorphine products) in the form
of an“Unrestricted Educational
Grant.” The
grant
is “unrestricted” so that
there are no “strings”
attached. NAABT, Inc. has complete
control
over how the funds are used, there
are no
restrictions on the content or mission
of this
site, and Reckitt has no control over
the
content of the site or NAABT’s
activities.
Reckitt is currently the only FDA approved
maker of a buprenorphine based product
for
addiction. NAABT, Inc. is not affiliated
with
Reckitt Benckiser.
Click
here to learn
more about NAABT. |
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