Feds OK expanded access to key opioid treatment

Doctors who treat opioid addiction with the drug buprenorphine will be allowed to prescribe to more patients, the Obama administration said Wednesday. Minnesota addiction specialists welcomed the change but said more needs to be done.

Buprenorphine, also known by the brand name Suboxone, can lessen opioid cravings, suppress withdrawal symptoms and block the effects of other opioids like heroin for a limited amount of time.

Buprenorphine prescriptions, however, have been limited to doctors who request a waiver and has been capped at 100 patients per doctor. The new rules from the U.S. Department of Health and Human Services will increase the number each doctor can treat with the medication to 275. The change starts Aug. 5.

Opioids are the family of drugs that includes both legal painkillers like Oxycontin and illegal drugs like heroin. The number of people dying of opioid overdoses has been steadily increasing across the country for the last decade and a half. More than 30,000 Americans now die each year of opioid overdoses.

Dr. Anne Pylkas, an addiction medicine specialist who practices at Sage Prairie Clinic and HealthPartners, said she was "ecstatic" that the buprenorphine treatment cap has been increased. She normally operates right near the 100 patient cap.

"I just can't help everybody I want to," she said. "I have to turn people away, and that just breaks my heart."

Adam Fairbanks, medication assisted treatment administrator with northern Minnesota's White Earth Nation, also applauded the change. White Earth Nation runs a treatment program that provides buprenorphine. It currently serves the maximum allowed number of 100 patients with 40 more people who want treatment on a waiting list.

"We're in a rural area with limited access to waiver doctors," Fairbanks said. "This is going to have probably its biggest impact on greater Minnesota."

While the rule change represents progress, Pylkas said it only partially addresses the lack of treatment options that many opioid users face.

There are still not enough doctors approved to prescribe buprenorphine, added Dr. Mark Willenbring, who runs Alltyr Clinic in St. Paul.

The Substance Abuse and Mental Health Services Administration lists only 130 doctors in Minnesota who are certified to prescribe buprenorphine. Willenbring said the larger health providers in the state have not moved towards providing treatments like buprenorphine in primary care settings, which for many people means it's not covered by health insurance.

"What they're primarily focused on is risk reduction and changing prescribing habits," Willenbring said, "and they're not focused enough on providing appropriate evidence-based treatments."

Pylkas and Willenbring said they'd like to see nurse practitioners also be allowed to prescribe the medication.

Buprenorphine is a partial opiate, which means it bonds with people's opioid receptors for between 24 and 36 hours, during which time other opiates, like heroin, are unable to access them. Essentially, buprenorphine blocks the heroin high. Because buprenorphine is a partial opiate, it also has potential for abuse.

Although treatment programs like Minnesota's Hazelden Betty Ford have started to offer buprenorphine as part of treatment in recent years, many traditional 12-step programs still frown upon using buprenorphine or other medication-assisted treatments like methadone.

Willenbring said treatment programs that don't offer medication that can save a patient's life are negligent, in his opinion.

"It would be like going to an oncologist because you had cancer and the oncologist knew of medications that had a very strong chance of putting you into permanent remission, but didn't tell you about it because she didn't 'believe in it,' so your cancer progresses and you die from it," Willenbring said. "What would you call that?"

President Barack Obama has proposed more than $1.1 billion in funding to expand Americans access to treatment, including medications like buprenorphine. The U.S. House and U.S. Senate are both considering bills to increase access to treatment options, but both are smaller than the president requested.

Administration officials on Tuesday called for Congress to pass the president's proposals and recommended level of funding.

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