Dr. Stuart Gitlow had to move his practice twice because neighboring professionals complained about the appearance of the people he treated. Other doctors say providing medication-assisted addiction recovery treatment opens them up to regulatory audits.
As the immediate past president of the American Society of Addiction Medicine's board of directors, Gitlow can attest to the difficulty in caring for addicts.
So he was lukewarm about the White House's newest plan to combat the opioid abuse epidemic. In a proposed rule, HHS would allow patient loads to be doubled for doctors who prescribe buprenorphine.
The move to bump patient limits from 100 to 200 was met with mixed reactions by health professionals and patient advocates, who say physicians often shy away from medication-assisted treatment because they don't have the staff, the financial incentive or the patience for the regulatory burdens needed to prescribe it.
In its announcement last week, the White House estimated the rule could increase treatment to “tens of thousands” of people with opioid-use disorders, but the level of unmet demand means the effort would be unlikely to save many lives.
According to the National Institute on Drug Abuse, roughly 23 million people age 12 or older needed drug- or alcohol-abuse treatment in 2009. But only 2.6 million received it.
“It will make a dent,” Gitlow said. “I'm not sure it's a particularly convincing dent.”
The opiate buprenorphine treats addiction to painkillers or heroin with less risk for abuse, or the physical and psychological effects of withdrawal.
Unlike methadone, which must be administered daily in a clinic, buprenorphine can be prescribed at a doctor's office and taken once a day at home.
Approved for opioid-use disorder treatment since 2002, buprenorphine access has been limited by federal rules that require interested physicians to undergo an eight-hour training seminar. Once authorized, a physician can initially treat up to 30 patients and then, after a year, ask to treat up to 100 patients.