Tuesday, May 24, 2011

Methadone vs. Suboxone

Lawrence Harmon's op-ed column on May 15th titled "Under the influence of methadone" offers a closer look at why Suboxone treatment is not widely used for addiction treatment in Massachusetts. He reveals that for 40 years, methadone has been the gold standard in addiction treatment. He adds that there is a growing consensus that Suboxone should be the first choice for treating patients with opioid dependence because of its effectiveness. Yet, Massachusetts state health officials do not embrace Suboxone and doctors are not actively seeking education about this drug.  He cites that MassHealth paid $325 million in 2007 to treat 18,000 low-income addicts with either methadone or Suboxone, and that a large majority ($276 million) was spent on methadone. Hence, there is an imbalance in that Suboxone is such an effective treatment but more money is being spent on methadone. Harmon goes on to discuss barriers to the wider use of Suboxone, such as patient prescribing limits and a shortage of prescribers. Following Harmon's article, a Question and Answer article appeared about Suboxone and approaches on opioid addiction treatment.  

What did physicians think about Harmon's article? In one piece "Pitting suboxone vs. methadone presents a false choice," Dr. Pace, a primary care physician, expressed that Harmon's argument that physicians and state officials should prioritize suboxone over methadone maintenance treatment represents a false choice and that while some patients are good candidates for Suboxone, others are not. In another comment, "No single medicine works for every patient, but stigma hurts all," Dr. Herbert shares that while she actively tries to educate other physicians and the community about addiction, insurance coverage can't keep apace with the number of people looking for treatment. She goes on to share that Harmon's article risks adding to the stigma surrounding addiction since patients have varied paths to recovery. Kevin Norton, president and CEO of a publicly funded addictions treatment facility responds in an article titled "No simple solution" where he adds that addiction is a complex chronic disease and hence no single treatment approach fits all.

Thursday, May 5, 2011

Patient Prescribing Limits

recent article tells the story of Carla, a 26 year old who started abusing marijuana, meth, and later moved on to prescription painkillers and heroin. She tried a methadone clinic to help kick her addiction, but to no avail. Later, she went to Dr. William Yarborough, an internal medicine specialist at the Univ of Oklahoma-Tulsa, who prescribed her buprenorphine. Since then, Carla has been clean and her quality of life has improved.

The article mentions that physicians may treat only as many as 100 patients at a time with buprenorphine according to the Drug Addiction Treatment Act of 2000. Dr. Yarborough has a very long waiting list of patients and just doesn't have enough spaces left to help people. Hence, he would like the regulations regarding buprenorphine prescribing limits altered. He adds that his patients who are treated with buprenorphine aren't the stereotypical addicts. He mentions "Most of my patients either go to school or they're working or taking care of their children. It's not the typical addict you think of. It's middle class and upper class". (Source: Doctor laments federal restrictions on drug treatment for addiction from Tulsa World)

A Closer Look at the 30/100 Patient Limit: Legal guidelines allow locations other than private practices to dispense buprenorphine. For instance, any opioid treatment program with a license to prescribe methadone can treat patients with buprenorphine, and there is no patient limit. Note that this differs from office-based treatment, in which each individual physician or group provider may treat only 30 patients with buprenorphine (including both detoxification and maintenance) at a time during the first year that the physician is certified, and up to 100 patients during each subsequent year. However, physicians who want to treat more than 30 patients after their first year must submit a second notification form to the DEA. For physicians in group practices, the patient limits apply to individual practitioners, not the group. For example, a group practice with 4 qualified physicians could treat 120 total patients (30 patients per physician) during the first year that the physicians are certified, and a total of 400 in each year thereafter. Get informed about the 30/100 Patient Limit on NAABT.org: http://www.naabt.org/30_patient_limit.cfm.