Medical associations say reimbursement and training must improve before a push to increase the number of patients using buprenorphine manages to curb opioid addiction.
The pleas to address what providers say are the biggest barriers to prescribing the alternative to methadone came recently in the form of comments regarding a new rule.
In March, the Substance Abuse and Mental Health Services Administration proposed bumping the amount of patients providers can treat with the drug from 100 to 200.
The Obama administration estimates the rule could increase treatment to “tens of thousands” of people with opioid use disorders.
SAMHSA received nearly 500 comments on the proposal prior to the May 31 deadline, and the consensus among medical providers seem to be that the impact of the rule would be small.
The American Medical Association said it would not help close the widening gap between the estimated 2.5 million patients who need treatment for opioid use disorder and those who are able to access it.
The group supported an American Society of Addiction Medicine proposal to raise the cap up to 500 patients.
Approved for addiction treatment since 2002, buprenorphine's access has been limited by federal rules that require physicians to undergo specialized training to prescribe it. Once a physician receives certification, he can initially treat up to 30 patients at one time and then, after one year, file a request to treat up to 100 patients.
The new rule requires practitioners to have an active waiver to treat up to 100 patients for one year and have subspecialty board certification in addiction medicine or addiction psychiatry or practice in a qualified practice setting.
The California Medical Society noted there were 1,460 providers actively prescribing buprenorphine in 2013 which amounts to approximately 3.9 providers per 100,000 people.
Physicians have been slow to prescribe buprenorphine because of low or no reimbursement, difficult documentation, lack of adequate training and education, and a lack of community behavioral supports, the CMA said. The American Academy of Family Physicians made similar comments.
The groups also say doctors who prescribe face complaints about their patients. Some doctors say neighboring professionals don't like the look of people with addiction.
The opiate buprenorphine is used to treat addiction to painkillers or heroin. Unlike those drugs, buprenorphine does not carry the same risks for abuse and does not carry the effects of withdrawal. Unlike methadone, buprenorphine can be taken once a day at home.
Practitioners seeking the higher patient limit would need to adhere to a number of requirements. Among would be offering patients behavioral health services such as addiction treatment counselors, something many providers say is lacking.
They would also need to use patient data to prove outcomes and participate in strategies to prevent patients from giving their prescribed opiates to another person illegally. Practitioners also would need to reaffirm their eligibility every three years.