vocabulary of addiction medicine
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:

  • Suboxone/Subutex® has proven to be uniquely safe and effective.
  • 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 physicians.

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 In July of 2005 It was abruptly withdrawn from the market because of evidence that the pills could be fatal to patients who take them with alcohol.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

precipitated withdrawal syndrome
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

what's new at 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 with stigma.

computer screen  

It is also a place for loved ones to ask questions to better understand addiction 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 sublingually.

in the coming months
• Advocacy
• Pregnancy and Buprenorphine
• Results of Patient Waiting List Pilot
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The National Alliance of Advocates for Buprenorphine Treatment is a non-profit organization formed to help people, in need of treatment, find treatment providers who are willing and able to treat opioid dependency in the privacy of a doctor’s office. Our website offers answers to frequently asked questions, a glossary, actual patient experiences, a discussion board, information on the history and treatments of opioid addiction, current news on the subject and more.

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