Treating heroin and opioid addiction
WASHINGTON – Across Michigan and our country, parents are struggling with how to help addicted sons and daughters. Husbands and wives worry about spouses caught in the grip of addiction. Rates of opioid abuse, heroin addiction, overdose and death are a concern in schools and hospitals, treatment centers and neighborhoods in every state.
One weapon in the fight against this epidemic is buprenorphine, a medication that helps to block the craving for heroin. Buprenorphine dramatically reduces the physical need for drugs and by doing so helps addicts and their families recover from the tragic damage that addiction can cause. The most commonly prescribed form combines buprenorphine with another substance, naloxone, which makes the medication less susceptible to abuse.
In 2000, I authored the Drug Addiction Treatment Act (DATA 2000) with Sen. Orrin Hatch, R-Utah, that made it legal for physicians to prescribe this medication in their offices, and the Food and Drug Administration approved its use in 2002. However, DATA 2000 established that physicians could only treat up to 30 patients at a time.
In 2006, Sen. Hatch and I held a forum to examine the patient limit and subsequently led the enactment of legislation to increase the patient limit from 30 to 100.
As the epidemic of heroin and other opioids has continued to spread to communities across the country, we were interested in looking at what obstacles are still preventing even greater numbers of patients from receiving buprenorphine treatment.
In May, I visited doctors across Michigan who are certified to prescribe buprenorphine. Almost every doctor said they must turn away patients seeking buprenorphine treatment because of the 100-patient limit. One had to turn away two patients the day we met. Another said that if all his 100 patients suddenly disappeared, he could replace all 100 within a month.
Doctors said other factors limit the drug’s availability: Medicaid in Michigan and many other states and many private insurance programs limit treatment to a year. As one doctor put it, “The insurance company would never tell me I have to be off insulin in 12 months.” Doctors describe the irony that there is no limit to how long a physician can prescribe the pain killers to which patients become addicted, while they can only prescribe a drug to help break that addiction for a year. Also, some said their patients struggle with the cost of the drug.
In June, Sen. Hatch and I held another forum with several medical professionals to learn more about buprenorphine’s successes and to seek ideas on how to identify and remove impediments to its use.
Two Michigan doctors testified and both spoke about the success of buprenorphine treatment, the difficulties of patient limits, and the need to expand the number of doctors certified to treat buprenorphine.
One doctor told a powerful story of his own experience with buprenorphine treatment. After building a successful career as a vascular surgeon, he required multiple back surgeries and during treatment for those surgeries, he developed an addiction to prescription opioids. He described the painful losses he suffered as a result of the addiction and how buprenorphine treatment enabled him to break his addiction and rebuild his life.
As he testified, “I couldn’t work anymore. I lost my home. And it has allowed me to come back and have a very active medical practice taking care of people with chronic pain and opiate addiction and has returned me to, I think, a functioning member of society.” He is now certified to treat patients with buprenorphine and has assisted many Michiganians in fighting addiction.
Another witness at the forum, a young mother in her 20s, said, “Today, I’ve been in treatment over four years. I have a good life. I have a stable life.” She continued, “I’m in school. I’ve actually done really well in school. I’m surprisingly smart. . . . I have a future, and my child has a future.”
As another witness who has been battling drug addiction for 40 years said, “If it can work on me, it can work on a lot of other people.”
At the Senate forum, we heard remarkable stories of success with buprenorphine treatment, of lives saved and families rebuilt from the ravages of addiction. But we also heard stories of frustration at the fact that many patients want this treatment but can’t get it.
We need to remove those hurdles. The forum was an important step in finding a way to get more patients the treatment they need.
The Buprenorphine Physician & Treatment Program Locator (buprenorphine.samhsa.gov/bwns_locator/) provides a state-by-state directory of physicians authorized to prescribe buprenorphine.
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Carl Levin is the senior U.S. senator from Michigan.