Feds to boost opioid treatment options, but seek far more funding

Jayne O'Donnell, USA TODAY

Federal regulators will nearly triple the number of patients doctors can treat with the most common drug to treat opioid addiction and plan to push Congress Wednesday to approve about $1 billion in funding to increase treatment options across the United States for the drug epidemic.

White House Director of National Drug Control Policy Michael Botticelli speaks at an event unveiling a multi-state program to combat opioid abuse in the U.S. at a Walgreens store on February 9, 2016 in Washington, DC.

The Department of Health and Human Services (HHS) also proposes to eliminate potential financial incentives for doctors to prescribe opioids out of fear that patients will give them low marks in patient experience surveys if they experience a lot of untreated pain after procedures.

Under the rule that takes effect August 5, physicians who are authorized to prescribe buprenorphine can go from having a maximum of 100 patients on the drug to 275. HHS estimates between 10,000 and 90,000 new patients will be able to get buprenorphine in the first year as a result. Another 2,000 to 15,000 new patients should be able to get the treatment in subsequent years.

If Congress would approve the budget request of $1.1 billion more, there would be more doctors trained in buprenorphine, particularly in rural areas where there is a shortage of physicians who can prescribe the drug, said White House drug policy director Michael Botticelli.

HHS Secretary Sylvia Burwell said the money is needed if "we truly want to turn the tide on this epidemic."

House and Senate conferees are expected to meet Wednesday on the conference report for the Comprehensive Addiction and Recovery Act, which would improve treatment for addiction and overdoses and reform prescribe practices.

Baltimore health commissioner Leana Wen, a physician, applauded HHS' announcements, but said there should be no limit on the number of patients doctors can treat with buprenorphine, which is often sold under the brand name Suboxone. She says the limit is based on the misconception that the treatment drug is potentially addictive.

"It's based on stigma and not science," says Wen. "There are no limits on opioid (patients) so why is there a limit on that?"

Baltimore Health Commissioner, Dr. Leana Wen is pictured during a June 2016 visit to USA TODAY headquarters in McLean, Va.

Kana Enomoto, principal deputy administrator of HHS' Substance Abuse and Mental Health Services Administration, said Tuesday that current drug law doesn't allow the agency to remove the limit on prescribing. Many of those who commented on the proposed rule warned about the risk of buprenorphine being diverted for illegal uses, she added.

Kana Enomoto is the principal deputy administrator at the Substance Abuse and Mental Health Services Administration. She has been delegated the duties of the Administrator to oversee an agency with four centers, four offices, over 600 employees, and a budget of $3.7 billion.

Many experts have cited this limit as a barrier to treatment for what is known as opioid use disorder. Opioids are controlled substances that are typically used to treat pain. The rule aims to increase access to medication-assisted treatment and therapy for tens of thousands of people with opioid use disorders, while preventing diversion, HHS says.

Botticelli also defended the cap, calling it only "one of the vehicles we're utilizing to increase access" to treatment.

Doctors told to avoid prescribing opiates for chronic pain

Department of Veteran's Affairs and Indian Health Service prescribers and pharmacists will also be required to check state Prescription Drug Monitoring Program databases before prescribing or dispensing opioids for pain. HHS is also launching more than a dozen new scientific studies on opioid misuse and pain treatment and soliciting feedback to improve and expand prescriber education and training programs.

"Expanding the use of the prescription drug monitoring program will help identify those who are addicted and trying to fill multiple prescriptions, and stop criminals from reselling opioids," said Becky Vaughn, of addictions at the National Council for Behavioral Health. "We applaud the commitment to more research, as well as increased opioid prescriber education and training so that providers can help people manage pain without the increased risk of addiction."

Patrick Kennedy, co-founder of the drugmaker-funded Advocates for Opioid Recovery, says HHS isn't going far enough. But he'll take what he can get.

"If this were pancreatic cancer or diabetes, this whole thing would be laughable," says Kennedy, who has battled addiction and mental illness. But the federal actions are "better than nothing even if it doesn’t amount to much."