The Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services (HHS), has issued a final rule that will expand access to buprenorphine, one of three medications currently approved by the Food and Drug Administration for medication-assisted treatment of opioid use disorder. The new rule increases the limit on the number of patients that qualified physicians can treat with buprenorphine from 100 to 275, increasing access to live-saving addiction treatment services.
The California Medical Association (CMA) supports the administration in its efforts to increase access to much-needed medication-assisted treatment for opioid use disorders, and submitted comments supporting the rule.
Across the country, many people suffering from opioid use disorder are unable to access medication-assisted treatment for their condition due to a lack of nearby physicians with waivers to prescribe buprenorphine. With more than 2.2 million people nationwide last year who met the diagnostic criteria for an opioid use disorder, increasing appropriate access to life-saving addiction treatment services is one component of a balanced approach to addressing rising opioid-related morbidity and mortality rates. Treatment of opioid use disorder with opioid maintenance therapies has been shown to be cost effective, safe and successful when used appropriately.
Despite the known effectiveness of this treatment, physicians have been slow to prescribe buprenorphine due to many possible barriers and concerns, including third-party reimbursement and documentation, stigma, lack of adequate training and education, and a lack of community behavioral supports.
“Medication-assisted treatment is proven effective, but for too long, too many patients have lacked access to this treatment," said American Medical Association (AMA) President Andrew W. Gurman, M.D. "[The] final rule is an important step that nearly triples the number of patients practitioners may treat with a waiver, but more must be done to leverage trained physicians to close the treatment gap.”
In another proposed rule, the Center for Medicare and Medicaid Services (CMS) is proposing to remove the hospital patient satisfaction survey questions related to pain management from the Medicare hospital payment scoring calculation. Under the proposed rule, hospitals could continue to use the questions to survey patients about their pain management experience, but the questions would not impact hospital payments. CMA supported 2016 federal legislation to delink the pain survey from hospital payments and welcomes this significant proactive regulatory action from CMS.
Additionally, HHS announced that it is launching more than a dozen new scientific studies on opioid use and pain management to help fill knowledge gaps and inform efforts to prevent and treat opioid use disorders. HHS is also seeking input from the medical profession and other health care stakeholders to improve the effectiveness and reach of prescriber education programs on opioid analgesics.
The White House in February announced plans to spend $1.1 billion to alleviate opioid abuse, but Congress has yet to make the needed appropriations. Congress has passed more than 25 new bills aimed at supporting opioid prevention and treatment strategies, and while they are being deliberated by a House-Senate Conference Committee, none of these bills comes close to providing the $1.1 billion investment advocated by President Obama.
CMA and AMA are supporting most of the legislative package and will continue to work with the conference committee and the administration to further refine the proposals, as well as promote additional funding for opioid prevention and treatment.
To read the HHS announcement in detail, click here.
To access CMA materials on safe prescribing, click here.