Buprenorphine ranks as the most common form of medication-assisted treatment for opioid addiction in the United States, according to federal officials. Of about 1 million Americans receiving that form of treatment in 2014, about 60 to 65 percent got buprenorphine, and most of the rest received methadone.
While addiction pain specialists consider buprenorphine one of the most effective forms of treatment, it is the only medication under such tight restrictions because it’s an opioid. Kelly Clark, president-elect of the American Society of Addiction Medicine, welcomed the new rule but said federal officials should lift the cap altogether.
“This is a good first step in improving access,” Clark said in an interview, but she added, “No one expects this to eliminate the access gap that exists.”
While policymakers are worried about buprenorphine becoming diverted or abused, Clark noted the areas of the country that lack sufficient treatment are the places where that phenomenon is most severe. “If there’s a high demand and low access, a black market will exist,” she said. “This is the strongest evidence-based treatment we have.”
HHS is also beginning a dozen new studies to better understand the opioid epidemic, and it is proposing a rule that eliminates the connection between the pain management questions in the Hospital Consumer Assessment of Healthcare Providers and Systems survey and payments by the Centers for Medicare and Medicaid Services.
Clinicians told HHS that “some feel pressure to overprescribe opioids because of the link between surveys of patients’ pain and payments to hospitals,” according to HHS Secretary Sylvia Mathews Burwell. “While we haven’t found evidence to support this concern, out of an abundance of caution we have proposed a rule to change that.”
In a conference call with reporters Tuesday, Burwell said the steps aim to push the fight against opioid abuse forward.
“They increase access to help more people receive the evidence-based treatment they need,” she said. “They help providers safely prescribe opioids while helping their patients manage chronic pain.”
But both Burwell and Michael Botticelli, director of National Drug Control Policy, said these steps were insufficient to address the scope of the crisis. Botticelli noted that the House and the Senate are slated to negotiate opioid legislation Wednesday, and that a GOP-drafted compromise “does not include the additional funding needed for treatment.”
Democrats are seeking an additional $920 million in treatment funding for states, which they argue can be paid with budget offsets.
“So there is still time for Congress to do what’s right,” said Botticelli, who noted that “only 12 percent of people who need treatment are actually getting it.”
Sen. Rob Portman (R-Ohio), who co-authored the Senate’s Comprehensive Addiction and Recovery Act, said a range of experts including administration officials “had significant input” into the bill, which passed 94 to 1.
“A coalition of 200 groups strongly support this measure because they know it will make a real difference in helping Americans put their lives back together,” Portman said. “The American people want results. Now is the time to act.”
Portman’s aides noted that overall federal funding for opioid programs is on track to more than double over the course of two years.
On Wednesday House and Senate conferees rejected an amendment to add additional treatment funding to the bill.
Gloucester, Mass., Police Chief Leonard Campanello, part of a group of law enforcement officials who came to the White House Wednesday to discuss the issue, called the rejection of funding “disgraceful” and “shameful.”
“We need the funding today, and it didn’t happen,” said Campanello, co-founder of the Police Assisted Addiction and Recovery Initiative.
An alliance of more than 30 medical and recovery groups, the Coalition to Stop Opioid Overdose, endorsed the compromise measure even as it lamented its lack of treatment funding.
“While we don’t expect that any final congressional action this year will fully resolve the opioid crisis — especially if it doesn’t include needed funding — enactment of legislation this year will serve as a building block for sustained and more aggressive efforts by federal, state and local elected officials and policymakers,” it said in a statement.
The House and Senate may very well approve the compromise bill by next week, before Congress adjourns for the summer. House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said Tuesday “there is an urgency to our work” given the extent of the epidemic. “Make no mistake — every single community is on the front lines in this fight.”
Neither Burwell nor Botticelli would say whether President Obama would veto opioid legislation that lacked sufficient treatment funding.