In 2000, the Drug Abuse Treatment Act (DATA) allowed for qualified physicians to use buprenorphine to treat addicted patients, but limited each physician to only having 30 buprenorphine patients at a time. In 2006, the law was amended to allow certain physicians to increase their patient load to 100, which is where it currently stands.
The 30 patient limit was imposed primarily due to a variety of concerns that had originated decades earlier when methadone was first made available for treating addicted patients. This limit was considered reasonable at the time it was passed as it was felt that there would be many physicians that would seek out the training necessary to provide this form of treatment, and thus enough space and openings would be available in multiple physician practices to absorb the demand.
It is clear from the statistics, and from my own personal experience, that this has not happened. Patients who suffer from addiction make up a distinct population with particular needs and problems associated with their care, and it can be very difficult for physicians in other specialties to take on addiction patients in addition to their own. The incentive to take on addiction patients shrinks even further when these physicians are confronted with a limit that will prevent them from taking on enough patients to build an addiction-centered practice on. I am very lucky in that I have managed to set up a practice that allows me to focus exclusively on addicted patients, but other physicians are forced under the limit to juggle the needs of addicted patients with the separate needs of patients with other illnesses, which may not be sustainable for them.
All of this contributes to a vacuum of care for addicted patients that allows many of them to fall by the wayside, or drives them to seek expensive and ineffective modes of treatment. I’ve discussed this issue a great deal in other posts, and I’ve talked about how the field of addiction care will not be standardized until more physicians are brought in. This is unlikely to happen while the 100-patient limit sets an arbitrary boundary on how involved a physician can be in this field.
We have also seen in the past five years that the fears that drove the creation of the limit were unfounded. Buprenorphine has several qualities as a drug which make it less abusable, less harmful, and less likely to be diverted than methadone was, and many of the problems that existed when methadone was the primary medication in the treatment of addiction have now been overcome. Moreover, buprenorphine has been on the market for over a decade, and so it is highly unlikely that giving qualified physicians license to prescribe it to more patients will cause any catastrophe. On the contrary, the stellar success that has been achieved by buprenorphine maintenance is a strong indicator that its use should be increased where indicated.
ASAM, the American Society of Addiction Medicine, came out with a statement condemning the 30-patient limit shortly before it was raised to 100 patients. The raising of the limit was a step in the right direction, but it has not solved the problem of a shortage of care for addicted patients. The shortage is an artificially imposed one, and it will continue as long as physicians are limited in the amount of patients they can have under their care. As long as the limit is in place, new physicians will be less willing to get the training and put in the effort to deal with addicted patients, and existing addiction care physicians will be unable to help the sick to the best of their ability.
While it would be irresponsible to invite physicians who don’t understand the situation of addicted patients to prescribe them medication indiscriminately, I do believe very strongly that physicians experienced in the field of addiction should have the artificial restrictions removed from their practices.
The NAABT, the National Alliance of Advocates for Buprenorphine Treatment, is trying to get the limits lifted this upcoming election cycle. They need patient and physician stories that illustrate the negative effects the patient limits are having on the treatment of addiction. If you have something to say, please send it to them. The following is a description of their plan, taken from the official NAABT website:
We plan to present all letters and data to the Department of Health and Human Services, where the Secretary has the authority to end the limit. We also are searching for a representative in Washington that will support our efforts and sponsor a bill to end this unnecessary and unprecedented rationing of lifesaving healthcare.
This coming election year will be a great time to bring forward this example of rationing healthcare.
Mailing address:
NAABT, Inc.
P.O. Box 333
Farmington, CT 06034Email address:
MakeContact@naabt.orgFax: 860-269-4391