GREENFIELD — For area residents trying to kick an opioid or heroin addiction, new federal rules announced this week will make accessing a medication used to keep drug cravings in check a bit easier.
The federal Department of Health and Human Services will now allow health care providers to obtain waivers to prescribe buprenorphine, known by the brand name Suboxone, to a maximum of 275 patients, nearly tripling the current 100 patient cap.
To get a waiver, the provider must have additional credentialing in addiction medicine or addiction psychiatry, according to a press release. The rule goes into effect in early August.
Locally, Clean Slate is one of the providers where those seeking addiction treatment can get buprenorphine and the other chemical replacement drugs commonly used to treat addiction: methadone and Vivitrol.
Dr. Kelly Clark, the organization’s chief medical officer, said increasing the cap on buprenorphine patients will simultaneously expand life-saving treatment options and reduce the black market concerns at the heart of the original limit.
“This mediciation, as well as the other two, are one of the best treatment modalities we have for opioid use disorder, and in the past physicians were really handcuffed since we could only prescribe for 100,” Clark said.
Clark noted that increasing the supply of the medication will do much more than restricting it to address diversion.
“Improved access will decrease diversion. If there’s high demand and low supply, you get a black market,” she said. “There’s no rational reason to deny patients access to an evidence-based treatment such as this medication.”
Prescribing buprenorphine first became legal in 2000 under the federal Drug Addiction Treatment Act. The drug mimics the effect opioids have on the body, blocking receptors that allow a drug user to become high on the drugs and taking away the cravings that drive them to use more.
Those effects increase with each dose until they level off at moderate doses, according to the federal Substance Abuse and Mental Health Services Administration. That “ceiling effect” lowers the risk of misuse, dependency and side effects. Buprenorphine is also long-acting, so some patients may not have to take it every day. The cap was originally put in place to prevent people from diverting the medication for sale on the street.
Raising the limit will make it easier for organizations like Clean Slate to recruit more full-time doctors who are willing to specialize in addiction and expand to new locations, in turn increasing the availability of treatment options statewide as overdose deaths related to the drugs continue to mount.
Dr. Ruth Potee, a local addiction expert and physician at Valley Medical Group, prescribes buprenorphine to her patients and described it as one of the “most effective tools in her arsenal” for addressing a patient’s addiction.
“It’s not a magic bullet that fixes everyone, but for about half the people who use it, it is life-saving,” Potee said. “The number one thing people say to me is that they feel normal again, they can go to school and things line up again. They’re able to allow their brain to heal. Many are weaned off of it eventually.”
Potee noted buprenorphine is one of the only mediciations that have a limit on how many people a doctor can provide it for.
“We prescribe a lot of dangerous drugs in our practice, so it seems silly to limit a drug that has such a low danger risk,” she said.
The new 275-patient limit, she noted, is higher than she and many of her colleagues expected.
The new initiatives will also aim to reduce overprescription of opioid painkillers, widely considered to be at the heart of the addiction epidemic.
Initiatives include launching a series of new studies to better track the crisis, develop new methods for treating addiction, better ways to manage pain, and reduce drug abuse.
It will also expand education and training for opioid prescribers.
Along with the new initiatives, President Barack Obama this week called for an additional $1.1 billion to be put toward fighting the opioid epidemic. Massachusetts stands to see up to $20 million of that, according to a White House fact sheet, if Congress approves the president’s budget proposal.
Northwestern District Attorney David Sullivan said that money could go a long way in preventing overdose among those already in the throes of an addiction.
“Our office has collaborated with first responders to ensure that Nalaxone (Narcan) is purchased and available for those persons overdosing from heroin or fentanyl,” Sullivan said. “With a growing amount of heroin being laced with fentanyl, addicted persons are at a much greater risk of fatally overdosing. Additional federal and state funding to help with purchasing Narcan has and will continue to save lives.”
Congressman Jim McGovern called fighting the opioid abuse crisis a “national priority.”
“Our families and communities in Massachusetts need a strong bipartisan response to the opioid epidemic and that is exactly what President Obama is calling for,” McGovern said in a press release. “Congress has a responsibility to do all it can to confront this crisis and this $1.1 billion proposal would help to expand access to treatment, strengthen prescription drug monitoring, enable safe disposal of unneeded drugs, and increase much-needed research on pain and opioid misuse and overdose.”
You can reach Tom Relihan at: trelihan@recorder.com
On Twitter: @RecorderTom