PolicyBrief:IncreaseAccesstoSuboxone

ThisPolicyBriefisintendedforproviders.

PolicyBrief:IncreaseAccesstoSuboxone

Summary
Prescribingtreatmentforopiatesismoredifficultthanprescribingopiates,thisisa
concern.ThetrendofUnitedStatesheroinuseisrisingithasgonefrom380,000individualsin
2005to670,000in2012.Ofthosethatuseheroin45%ofheroinaddictsbeginwithanopiate
prescription.Alongwiththeriseofheroinusetherehasalsobeenariseinsuboxoneneed.
Peopleseekingtreatmentforopiateuseisrisingand47%oftreatmentfacilitiesaredoingsoat
capacityortreatingat108%forcapacity(U.S.DepartmentofHealth.2013).InWashington
StateaccordingtotheCBHSQdatareviewreport,83%ofpeoplewhoneedaddictionrelated
treatmentdidnotreceivespecialitytreatment(2014,p120).
Opiateusersareseekingtreatment,andalthoughunfortunate,treatmentcentersandcertified
doctorsarehavingtoturningpatientsawayduetothecurrentsuboxoneprescribingpolicies.
Anotherstrikingstatistic,Ofthe39countiesinWashingtonState,14ofthesecountieshaveno
physiciansthatprescribesuboxone.(Hutchinson,et.al,2014).

Background
AccordingtotheNationalInstituteofDrugAbuse(NIDA)statesthattodatethereare
800,000physiciansinAmerica,lessthan30,000ofthemarecertifiedtoprescribesuboxone
andofthose30,000approximatelyactivelyprescribesuboxone(2014).Anotherstudyin2011
sawsimilarresults.AWashingtonStatestudyattemptedtocertify120doctorsforopiate
addictiontreatmentin2010andsevenmonthslatersurveythecertifieddoctorsforeffectiveness
ofthecertificationprocess.Ofthose120,22wereactivelyprescribingsuboxone(2014).

Doctorsthatarecertifiedtoprescribesuboxonestatethatbarriersforprescribingsuboxone
include:
lackofmentalhealthprofessionals
lackofinstitutionalsupport
timeconstraints
resistancefrompracticepartners
lackofspecialtybackupwithininstitution
reducedconfidenceinprescribing
concernsaboutreimbursement

Duetothecomplexityanddifficultiesthatthispopulationpresents.Practitionersworkingoutside
ofanaddictioncenterthathavetakentherequiredcertificationcoursehavealimittothe
amountofpatientsthattheyareabletoprovidetreatmenttoThisisthe30/100policy.Which
limitstheprovidertoseeingamaximumof30patientsthefirstyearandiftheproviderapplies
forasecondwaiver,uptoamaximumof100patientsafterthatfirstyear.

Practicethatthe30/100policypromotes:
creationofthewaitinglist,wheredeathbyoverdoseisaneminentpossibility.
dischargeofapatientnotreadytobedischargedtoacceptapatientwithhigher
acuity.
incompetenceduetothelackoffocusforspecializinginaddictionmedicinedue
tolowpatientvolume.
Practicingthe30/100policyisagainsthavingeffectivetreatment.TheNationalInstituteofDrug
Abuse(NIDA)has13guidingprinciplesforeffectivetreatment.The30/100policyplaces
barrierstoimplementingtwoessentialprinciples:tohavetreatmentbereadilyavailable,andto
haveaccesstomedicationthataidsintreatment(1999).

Recommendation:
Removethearbitrary30/100policy,doctorsshouldbeabletoselfregulatethe
amountofpatientsthattheyareabletoprovidetreatmentfor

Addfinancialincentivesforseeingthispatientpopulation.Thispopulationof
patientscarryauniquesetofneedsthatwhennotspecializedinnavigatingthis
patientpopulationitmakesprovidingcaredifficult

Streamlinetheprocessofconnectingthepatientwithmentalhealthtreatment
andchemicaldependencycounselors.Createacomprehensiveapproachthat
includesateamandacommunity.

Createtheinstitutionalcultureoftreatment.Thiscanbeachievedthroughfocus
onaddiction,sendaprovidertoanaddictionconference,haveaspeakercome
andtalkaboutaddiction.

Reachouttopatientswithaddictionandhaveresourceconnectionsforpatients.
makeiteasyforthepatienttofindhelp.

EndingStatement:
PresidentObamawithinthelastyearhasincreasedthebudgettoaddresstheopioid
epidemic
grantsthroughtheCDCforoverdosepreventionstrategiesareawarding$750,000
$1millionandWashingtonisnotonlisttoreceivefunding(2015).DoasFrancehasdoneand
haveanopensuboxonepolicy.WiththeopenpolicyFrancehasseenareductionofHeroinuse
by80%,andthespreadofHIVinthispopulationreducefrom20%inthe90sto6%in2010
(Polomeni,2014).Suboxoneisnotintendedforeveryone,forthosethatitisintended,itcanbe
alifesaver.

Reference

Batts,K.,Pemberton,M.,Bose,J.,Weimer,B.,Henderson,L.,Penne,M.,Joseph,G.,Trunzo,
D.,Strashny,A.(2014).CBHSQDataReview.CenterforBehavioralHealthand
StatisticsQuality.
ComparingandEvaluatingSubstanceUseTreatmentUtilization
EstimatesfromtheNationalSurveyonDrugUseandHealthandOtherDataSources.
Retrievedfrom:
CentersforDiseaseControlandPrevention.(2015).InjuryPrevention&Control:Prescription
DrugOverdose.
PrescriptionDrugOverdosePreventionforStates.
Retrievedfrom:
http://www.cdc.gov/drugoverdose/states/state_prevention.html
Hutchinson,E.,Catlin,M.,Andrilla,C.H.A.,Baldwin,L.M.,&Rosenblatt,R.A.(2014).Barriers
toPrimaryCarePhysiciansPrescribingBuprenorphine.
AnnalsofFamilyMedicine,

12
(2),128133.
http://doi.org/10.1370/afm.1595
NationalInstituteonDrugAbuse.(1999).NIDANotes.
ThirteenPrinciplesofEffectiveDrug
AddictionTreatment.
14(5).Retrievedfrom:
https://archives.drugabuse.gov/NIDA_Notes/NNVol14N5/Tearoff.html
TheNationalAllianceforBuprenorphenTreatment.(2015).Endthe30/100PatientLimitson
Care.Retrievedfrom:
http://www.naabt.org/reasons.cfm
OfficeofthePressSecretary.(2016).TheWhiteHouse.
FactSheet:PresidentObama
Proposes$1.1BillioninNewFundingtoAddressthePrescriptionOpioidAbuseand
HeroinUseEpidemic.
Retrieved
from:https://www.whitehouse.gov/thepressoffice/2016/02/02/presidentobamapropose
s11billionnewfundingaddressprescription

Polomeni,P.,Schwan,R.,(2014)InternationalJournalofGeneralMedicine.
Managementof
opioidaddictionwithbuprenorphine:Frenchhistoryandcurrentmanagement.4(7),

143148.
http://dx.doi.org/10.2147/IJGM.S53170