Maine Providers Welcome Expansion of Access to Opioid Treatment Drug

Sep 17, 2015

PORTLAND, Maine — The U.S. Department of Health and Human Services announced Thursday it will revise its prescribing limits for a drug used to treat opioid dependence.

The move to expand access to buprenorphine — commonly known as suboxone — comes as states across the country struggle with a rise in opiate drug abuse.

Many treatment providers in Maine say the move is long overdue.

Maine health providers who offer treatment for opiate addiction say patients and families are desperate for help. Martin O'Brien of Grace Street is one of many providers who say they have long wait lists for buprenorphine treatment.

"We're admitting about 8 patients a week, and not admitting 18," he says.

The reason for the wait list, O'Brien says, is a federal cap on how many patients physicians can treat.

Currently, those certified to prescribe buprenorphine can only treat 30 patients initially. After one year, they can treat a maximum of 100 patients.

"It's the only medication in the country that has limits to it," O'Brien says.

But those limits will soon be relaxed. On Thursday, U..S Health and Human Services Secretary Sylvia Burwell announced her agency will revise the buprenorphine cap in order to expand access to medication-assisted treatment.

A recent HHS report found that 2.5 million people in the U.S. need treatment for opioid use, but fewer than 1 million receive it.

"This is really a tremendous and long-awaited change in federal policy," says Dr. Mark Publicker, past president of the Northern New England Society of Addiction Medicine. "Since buprenorphine came on the market in 2002, addiction medicine doctors have been in an impossible and absolutely unique situation of having to ration a life-saving medication."

There are three FDA-approved drugs for medication-assisted treatment for opioid addiction. Methadone is a common treatment, but Portland physician Dr. Mary Dowd says it must be taken daily.

Buprenorphine, on the other hand, "can be done in an outpatient setting — you can get a prescription over the phone, you can get refills on it — it's an easier thing to do, just administratively for the physician," she says.

The fact that it can be delivered in an outpatient setting also provides easier access in rural areas.

But the revised guidelines for buprenorphine are a double-edged sword for Brent Miller of the Discovery House in Bangor. While he welcomes more access, he says treatment requires more than just medication.

"It means counseling," he says. "It also means diversion control. The behavior monitoring aspect of the people who have this disease and helping them change their thinking and their behaviors in the long term so they have long-term recovery."

If physicians increase their patient load, Miller worries whether they will be able to provide all the other services necessary. It's a question the Discovery House will have to consider, he says, before they take on more patients.

Publicker agrees it's critical that physicians provide comprehensive treatment that extends beyond buprenorphine. But at least the restrictions on medication will be eased, though exactly how much is unclear at this point.