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.

 

At drug summit, Obama arrives bearing gifts

Moderator Sanjay Gupta listens as President Barack Obama speaks during a panel discussion at the National Rx Drug Abuse & Heroin Summit at AmericasMart in Atlanta, Tuesday, March 29, 2016. (AP Photo/Jacquelyn Martin)
Moderator Sanjay Gupta listens as President Barack Obama speaks during a panel discussion at the National Rx Drug Abuse & Heroin Summit in Atlanta. (AP Photo/Jacquelyn Martin)

What’s the use of being the commander in chief unless you can do a little commanding from time to time?

Which is why President Barack Obama didn’t show up empty-handed Tuesday afternoon at the 2016 Summit on RX Drug Abuse and Heroin in Atlanta. He had executive branch agencies arrive bearing gifts. Among them:

  • Health and Human Services (HHS) is issuing a proposed rule to increase the current patient limit for qualified physicians who prescribe buprenorphine to treat opioid use disorders from 100 to 200 patients. HHS had already released $94 million in new funding to 271 community health centers, with a specific focus on expanding medication-assisted treatment of opioid addiction and abuse- it could assist 124,000 new patients.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) is releasing a $11 million for up to 11 states to expand medication-assisted treatment for addiction.
  • Back to HHS: Information on HHS-funded programs regarding the use of federal dollars to start or expand needle exchanges.  Obama last year reversed the longstanding ban on federal money for such programs.
  • Also from the White House, an announcement that more than 60 medical schools, beginning in fall 2016, will require their students to take some form of prescriber education, the better to curb the kind of prescribing that has resulted in 215 million U.S. prescriptions for narcotics every year. The only Florida school named: University of Central Florida College of Medicine.

“Very rarely is money the answer alone,” said Obama to a crowd of about 2,000. “But it helps.”