It’s easier to get a prescription for drugs that cause opioid addiction than those proven to treat it

In this series, Yahoo News takes a closer look at the current opioid epidemic, its roots and demographics, the increasing acceptance of medication-assisted treatment as a supplement to 12-step programs and the remaining obstacles to combating widespread addiction. This series also highlights ways in which the current crisis is unexpectedly forcing a larger shift toward treating addiction more like other chronic illnesses. 

This month, President Obama announced a proposal for $1.1 billion in federal funding to combat the country’s heroin and opioid abuse epidemic — $1 billion of which is to be used in the expansion of access to treatment.

A study published in October 2015 by the Johns Hopkins Bloomberg School of Public Health found that despite the drastic rise in fatal opioid deaths over the past 10 years, the number of people receiving treatment for heroin and prescription painkiller abuse had not changed.

“We found that 80 percent of people with an opioid addiction are not getting treatment,” said the study’s leader Brendan Saloner, PhD, who pointed to limited access to medication assisted treatments like buprenorhine as one explanation for this major disparity.

Buprenorphine has been highly restricted since it was first approved for treating opioid addiction as part of the Drug Treatment Act of 2000. Minor legislative actions have helped loosen these restrictions somewhat over the years. In 2005, an amendment to the Controlled Substances Act repealed the original law’s provision that prohibited medical practices, regardless of how many qualified physicians they employed, from prescribing maintenance medications such as buprenorphine to more than 30 patients at a time—a limit intended prevent doctors’ offices from turning into buprenorphine mills. A 30-patient limit was instead imposed on each individual physician qualified to prescribe the drugs.

With the passage of the Office of National Drug Control Police Reauthorization Act in 2006, the maximum number of patients increased from 30 to 100, where it remains today.

“I’ve had hundreds on the waiting list for years,” said Dr. Stuart Gitlow, president of the American Society of Addiction Medicine. Gitlow treats patients for substance use disorder at his private practice in Rhode Island and said he’s been prescribing buprenorphine for opioid addiction for about 10 years.

The problem with the patient cap, Gitlow explained, is that buprenorphine “is a maintenance drug. You get to your limit pretty quickly and, if you have stable patients on medication for years, how can you add?”
Like Phoenix House’s Andrew Kolodny, Gitlow likens medication for opioid abuse to that of other persistent conditions, like diabetes or hypertension.

“When you’re talking about a chronic, lifelong disease, the expectation is you're going to have to be in treatment forever,” Gitlow said. “The disease is not about the use of heroin or narcotics, the disease is how you feel when you’re not using them.”

According to the department of Health and Human Services, 40 percent—or 1 million—of the 2.5 million people in the U.S. who need treatment for opioid abuse are getting it. The President’s recent $1.1 billion proposal was an effort to redirect resources to making addiction treatment more available.

In September New York Governor Andrew Cuomo signed a bill to allow medication-based treatments for drug defendants in judicial diversion programs.

The New York law was prompted by the White House Office on National Drug Control Policy, which announced earlier last year that the federal government would no longer provide funding to drug courts that penalize addicts for using such treatments.

The warning to drug courts and judges around the country echoed other recent efforts to use federal funding as an incentive to increase access to opioid abuse medication.

In August 2015, the Substance Abuse and Mental Health Services Administration, or SAMHSA, revised its grant language to promote the use of medication-assisted treatment for opioid addiction.

Then, in September, U.S. Department of Health and Human Services Secretary Sylvia Burwell announced a plan to loosen restrictions on doctors prescribing buprenorphine. It was the biggest victory yet for physicians like Gitlow and Kolodny, who advocate in favor of removing barriers to the medication.

Nearly six months later, however, Burwell has yet to implement any specific changes to the current restrictions.

“Updating the regulation around the prescribing of buprenorphine is an important step to increasing access to evidence-based treatment - helping more people get the treatment necessary for their recovery,” an HHS spokesperson told Yahoo News when asked for a timeline on Burwell’s proposed changes. “This is a priority for the Department and we are working to move forward as quickly as possible.”

Read more from this series:

—This is your brain on opioids 

—How buprenorphine, or ‘bupe’, changed opioid addiction treatment

—Abstinence vs. medication-assisted treatment: Traditional 12-step programs embrace a new model 

—The menace in the medicine cabinet: The opioid epidemic’s pharmaceutical roots

—The rise of Narcan, the life-saving opioid antidote that can stop an overdose in its tracks 

—Why the new face of opioid addiction calls for a new approach to treatment

—Facing an epidemic of overdoses, Obama rejects governors' proposal to limit painkiller prescriptions