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Opioid Abuse Fears Flare As Pols Propose Lifting Cap On Addiction Medication
Antonio Planas, Jack Encarnacao Monday, June 06, 2016
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Credit: Reuters
‘MISUSE AND DIVERSION’: Some lawmen and doctors are speaking out against a bipartisan effort to increase the current limit of 100 Suboxone patients per doctor to 500.



Doctors and lawmen are sounding the alarm on the potential proliferation of the heroin-addiction drug Suboxone as Bay State U.S. Sens. Edward J. Markey and Elizabeth Warren push a bipartisan bill that could increase accessibility to the controversial medication five-fold.

Markey, Warren and 20 other senators — including Bernie Sanders and Rand Paul — urged Health and Human Services Secretary Sylvia Burwell in a letter last week to increase the current limit of 100 Suboxone patients per doctor to 500. Markey and Paul have drafted legislation that would similarly raise the cap.

Critics say the opioid derivative buprenorphine, also known as Suboxone, is abused and sold on the black market and prisons as a narcotic. Last week, Arlington police said a toddler had to be treated with Narcan and hospitalized after ingesting Suboxone that belonged to someone in her home.

Bristol County Sheriff Thomas M. Hodgson said he is against increasing Suboxone’s accessibility, adding he doesn’t allow its use in his jail’s detox program.

“Giving drug addicts medication is not the way to do it,” Hodgson said, noting the drug is “abused.”

John Birtwell, a spokesman for Plymouth County Sheriff Joseph McDonald, said although McDonald is not opposed to Suboxone treatment, there have been more than a half-dozen instances in the past decade of “illicit Suboxone being brought into the facility,” and he is concerned that could increase. Middlesex Sheriff Peter Koutoujian told WGBH last year, “Suboxone is the most smuggled contraband in corrections today.”

A ProPublica study of 2013 Medicare claims found doctors in Massachusetts filed more reimbursement claims for Suboxone than any other state. The 41,827 claims were nearly 40 percent more than second-place Pennsylvania.

Dr. Elinore McCance-Katz of the Rhode Island Department of Behavioral Health — co-chairwoman of the International Conference on Opioids now convening at the Harvard Medical School — said dramatically boosting Suboxone prescriptions could lead to “misuse and diversion.”

“I do think that in the hands of individuals who don’t have that training and that skill set in appropriate treatment of addiction, that raising the limit may contribute to misuse and diversion of the medication,” McCance-Katz said. “So I think we need to be careful about those issues. ... It will be helpful in some areas, but it’s not going to solve the (opioid addiction) problem we have.”

But McCance-Katz added that she believes a cap-lift might prove “very useful” to qualified addiction specialists, if there is proper monitoring of the drugs.

Dr. Katherine Gergen Barnett, a Suboxone prescriber at Boston Medical Center, called the proposed five-fold increase is a “tremendous step in the right direction,” however, though she also said doctors must be able to ensure patients are committed to counseling and have support when prescribing the drug.

“It’s not just about the medication. It’s about the entire way the care is delivered,” Barnett said.

The senators’ letter states: “The current 100 patient cap is one of several factors that have created a huge disparity between those who can prescribe opioids for treatment of pain and those who can prescribe treatments for opioid use disorders. Only 10 percent of 23 million Americans with addictions and substance use disorders receive any care in a given year.”

The letter says the U.S. Department of Health and Human Services’ proposed cap lift from 100 to 200 “will be unlikely to make the meaningful impact needed in the marketplace to make buprenorphine a viable treatment option for patients.”

Markey and Warren did not respond to requests for comment yesterday.

Suboxone is a semi-synthetic opioid derivative that is used as treatment for addiction to heroin and other opioids. It is manufactured by Indivior, which has lobbied Congress on the Recovery Enhancement for Addiction Treatment Act, the bill that contains the 500-patient cap lift as well as provisions to allow nurse practitioners and physician assistants — not just doctors — to treat opioid addicts with medication.

Lobbyists on the bill have also included the New England Council — an alliance of businesses, academic and health institutions focused on economic growth — and Alkhermes, a drug company founded in Waltham that has studied using buprenorphine to treat cocaine addiction. Alkermes’ political action committee has contributed thousands in recent years to the campaigns of Markey and several Senate cap-lift bill sponsors.

Gov. Charlie Baker is due to speak at the opioid conference tomorrow. His office said in a statement yesterday: “The governor believes the opioid epidemic transcends partisan boundaries and applauds Congress for targeting additional reforms.”



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