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Suboxone and the TREAT Act: What’s Taking So Long?

We’ve all heard about the TREAT Act and its effect on the availability of buprenorphine formulations like Suboxone. The TREAT Act, also known as Senate Bill 2645 or The Recovery Enhancement for Addiction Treatment Act, if passed, means that Suboxone, Subutex, and other forms of buprenorphine will be available for more people and waiting lists reduced. So what’s the holdup?

The bill’s original sponsor was Massachusetts Democratic Senator Edwin Markey. He introduced the bill in 2013 along with 6 co-sponsors, including Diane Feinstein (D-CA), John D. Rockefeller IV (D-WV), Sherrod Brown (D-OH), Mazie Hirono (D-HI), Richard Durbin (D-IL), and Carl Levin (D-MI). All of the co-sponsors jumped aboard the bandwagon on July 23, 2014, when the bill was read aloud—twice—in the Senate. It was then referred to Committee. And there it sits.

The bill begins with the usual heading of the “findings” that spurred its introduction. In the case of Suboxone and the TREAT Act, there is admission that overdoses from opiate drugs have increased dramatically in the United States. There is admission that drug overdose fatalities now claim more lives on the national level than auto accidents. Opiate addiction is identified as a chronic disease that can weigh down our national healthcare system, with 475,000 emergency department visits attributable to opiates each year. Suboxone and the TREAT Act are tied together when section 2, item 8, admits that access to buprenorphine is restricted due to current legislative limitations and an insufficient number of providers.

The TREAT Act then enters the second part of the bill, which addresses Expansion of Patient Limits Under Waiver—presumably referring to the Data Waiver Act of 2000. That Act limits a physician who wants to prescribe Suboxone or buprenorphine to no more than 30 active patients at a time during their first year of buprenorphine practice and no more than 100 active patients in subsequent years. The bill’s sponsors recognize that more lives would be saved if more people had access to Suboxone. And the TREAT Act not only does away with the 30-patient and 100-patient limits; it also suggests expanding prescribing authority. That means that doctors would be able to prescribe it and also nurse practitioners and physician assistants.

Suboxone and the TREAT Act: Follow the Money

Therein lies the rub. There’s a lot of money to be made prescribing buprenorphine in all its formulations. There are many wonderful methadone and buprenorphine treatment programs that offer opiate addiction treatment in clean, caring settings. They are certified by the Commission on Accreditation of Rehabilitation Facilities. They offer individual, group, and even family counseling. You can’t get into a better place—if you could just get in. There are wait lists for those kinds of places in many parts of the country.

Then there are the other places, places you really wouldn’t want to go. Doctors hire one or two receptionists as their entire staff and hang out a shingle that they will prescribe Suboxone. And the TREAT Act does not address how they practice—they sign up and line up their patients, pass out buprenorphine, collect the bucks, and move patients out like so cattle. Such doctors can make a lot of money. They charge their patients for the office visit and for the buprenorphine and they require frequent visits. They don’t care if the person receives any counseling to help them learn why they became addicted in the first place. They don’t care if the person ever sees the inside of a 12-step meeting. They’re just in it to earn the money. Those doctors are against passage of the TREAT Act.

The Good, the Bad, and the Vain

There are many physicians who practice medicine and treat opiate addiction with a clear conscience. They care about their patients and do the best they can. However, they are simply unwilling to see the authority to prescribe Suboxone, as the TREAT Act states, expanded to include nurse practitioners and physician assistants. They realize that their objection to this expansion keeps waiting lists long and they know that people die from opiate addiction waiting to get into treatment. And for them it’s not about the money. But they just can’t give up their physician-given right to be the sole prescribers of Suboxone.

The nurse practitioners who would be included to prescribe Suboxone if the TREAT Act passes must have at least 24 hours of training and must be scheduled to dispense Schedule III, IV, and V medications that are normally reserved for pain management.

Even though nurse practitioners and physician assistants would have to practice under the supervision of a physician who has met Data Waiver Act requirements, physicians are objecting to the idea that nurse practitioners or physician assistants would carry the necessary authority. That’s where the money trail leads: Too many doctors feel that their cut of the Suboxone market is threatened by nurse practitioners and physician assistants. They ignore the fact that those paraprofessionals couldn’t practice without supervising practitioners, anyway.

Take a look at the American Society of Addiction Medicine’s webpage containing physician comments: One doctor writes, “It would be ridiculous to allow everyone to write Buprenorphine…why then have a specialty of Addiction Psychiatry and Addiction Medicine and Board Certifications in this field…Maybe we don’t need medical schools…” while another one writes, “I would not support a bill that in my opinion diminishes my area of specialty…” Physicians like those are putting their own vanity ahead of patients’ lives.

What Can You Do?

If you know someone who has had difficulty getting into treating with Suboxone, the TREAT Act can still help them if it’s passed. Write to your senator and tell them that it will save lives and that it needs to be passed. Use the link here to contact the U.S. Senator in your state and tell them that this bill must get out of Committee and back on the floor.

In the meantime, if you need opiate addiction treatment, get your name on a waiting list now. The lists often become shorter more quickly than you think. And if you don’t add your name, it will never be your turn anyway. The best way to get into a Suboxone program is to visit your local medication-assisted treatment program, ask for an assessment, and just keep moving forward.

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