Dr Kelly Clark on Physician Limitations to Opioid Addiction Treatment

While there is no limit on the number of patients a physician can prescribe buprenorphine when sought for pain, physicians face governmental limitations on prescribing this medication to patients who need it as treatment for opioid addiction, said Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine. These restrictions have in turn created several patient access roadblocks to the needed medication.

Transcript (slightly modified)

What government constraint is in place when it comes to opioid addiction treatment? And how does it affect patients?

Buprenorphine can be prescribed for pain under federal law with no limits for the number of patients a doctor or an advanced practice clinician can prescribe. Similar to the way they can prescribe any other opioid for pain without any limits.

However, there is a limit on the number of patients that a physician can prescribe buprenorphine for to treat addictive disease. And advanced practice clinicians right now are not allowed to prescribe it for addictive disease, only for pain under federal rules. Doctors can prescribe for 30 patients at any 1 time during their first year of being licensed to use buprenorphine and, thereafter, only 100 patients at a time. Now that’s led to waiting lists in many parts of the country and we know of people who’ve died while being on a waiting list to get on the most evidence-based treatment we have for opioid addiction, which is the use of medication.

That’s an artificial government constraint on the ability of doctors to prescribe and take care of patients.

What is being done to change this artificial government constraint on buprenorphine treatment for opioid addiction?

Well, the Department of Health and Human Services has proposed raising that cap to 200 patients per physician. They do not have the power to allow advanced practice clinicians to prescribe. There are bills currently in the Senate (the TREAT Act) as well as in the House (the Bucshon-Tonko), which would both raise the limit for physicians to prescribe and allow advanced practice clinicians, or physicians’ assistants, or nurse practitioners to prescribe.

So it is being addressed currently, legislatively as well as through regulation through the Department of Health and Human Services.