How many addicts is too many to treat?

Physicians who prescribe buprenorphine to treat opioid addiction will no longer be limited to 100 patients. Under a rule change announced during a White House press conference on Tuesday, the new rule increases from 100 to 275 the number of patients that qualified physicians can treat.

Hypodermic needles mixed with cigarette butts and empty prescription bottles filled garbage bags recovered from a cottage apartment rented by Jean Thomas, 83, in West Palm Beach's Prospect Park neighborhood. (Thomas Cordy / The Palm Beach Post)

(Thomas Cordy / The Palm Beach Post)

The announcement came as lawmakers today consider the President’s request for $1.1 billion to address the nation’s opioid epidemic, fueled largely by cheap heroin laced with the powerful painkiller fentanyl. Opioid overdoses kill 129 people every day in the U.S.

Buprenorphine, also known by the brand names Suboxone and Subutex, is among a handful of drugs that block the high produced by heroin and other opioids, such as Percocet and Oxycodone, and prevent the addict from suffering the painful side-effects of withdrawal.

These drugs – if misused – can produce a high. To prevent “diversion” – using the drugs to get high rather than to wean an addict off opioids – qualified physicians were only allowed to treat 100 patients with the drugs.

Critics claim that medication-assisted treatment with drugs such as buprenorphine still leave addicts dependent on a drug. They question whether a physician can adequately care for 275 addicts at once and fear buprenorphine clinics may become the new pill mills.

Still, providers, policymakers and experts have pointed to the current 100 patient limit as a barrier to treatment. Administration officials estimate the increased limit coupled with the President’s $1.1 billion budget request will enable 70,000 addicts to access treatment next year.

Under the President’s budget proposal, Florida would be eligible for up to $47 million dollars over 2
years to expand access to treatment. However, the final amount the state could receive depends on congressional approval of the budget and the strength of the State’s application and plan to combat the epidemic.

Florida lawmakers have expressed little interest in addressing the state’s heroin epidemic even though the state – especially south Florida – is considered the recovery capital of the U.S. A Palm Beach Post investigation of the county’s drug-treatment industry revealed evidence of patient-brokering, insurance fraud and kickbacks.

This year lawmakers reluctantly approved a bill that would allow researchers at a Miami hospital to operate a needle exchange program and shot down efforts to control unethical marketing practices in the billion-dollar drug treatment industry.

The homepage of the State’s Dept. of Health is devoted to controlling the spread of the Zika virus. Its “Programs and Services” menu makes no mention of addiction services.

Still unresolved is how uninsured addicts who wish to get clean will find in-patient beds during the initial detox procedure – which takes an estimated 7-10 days. Administration officials said Tuesday that grants will enable communities to develop programs to provide such care.

In Palm Beach County, the Drug Abuse Foundation in Delray Beach is the primary provider of in-patient detox beds for addicts who have no insurance and cannot afford to pay for detox. There is often a waiting list for those beds.

 

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