Obama Proposes Raising Caps on Buprenorphine Prescribing

The White House in March announced a host of public and private sector initiatives addressing the nation’s opioid epidemic, including a proposal to increase the current patient limit for qualified physicians who prescribe buprenorphine to treat opioid use disorders from 100 to 200 patients.

Additionally, more than 60 medical schools announced that, beginning in fall 2016, they will require their students to take some form of prescriber education, in line with the newly released Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain, in order to graduate (Psychiatric News, April 15).

President Obama, in an address at the National Rx Drug and Heroin Abuse Summit in Atlanta where he released the proposals, also announced the creation of an interagency task force to advance access to mental health and substance use disorder treatment, promote compliance with best practices for mental health and substance use disorder parity implementation, and develop additional agency guidance as needed. 

The task force will work quickly across federal departments and with diverse stakeholders to identify and promote best practices for executive departments and agencies, as well as state agencies, to better ensure compliance with and implementation of requirements related to mental health and substance use disorder parity. The task force will also look to determine areas that would benefit from further guidance. They will present a report on their findings to the president by October 31.

APA President Renée Binder, M.D., called the task force “a very constructive step” and said gaps remain in enforcement of federal parity, especially around treatments for substance use disorder. “The establishment of the task force will increase visibility of this issue (federal law requires nondiscriminatory treatment of these patients by health plans) and highlight its significance,” she said. “The particular emphasis on substance use disorder parity is warranted. This is an area where we have seen greater variability in plan policies regarding treatment options. This is important for persons with primary substance use disorder conditions, and also for our patients who have other psychiatric diagnoses with substance use disorder as a comorbidity.”

Binder added, “APA is strongly encouraged that the timeline for this task force’s work is focused. The report is due October 2016, and its charge stipulates that actions need to be implemented during its tenure and be completed by the end of its tenure.”

The proposal to lift caps on buprenorphine prescribing met with preliminary approval from APA leaders. “These are very important steps to improve the accessibility of buprenorphine,” Frances Levin, M.D., chair of the APA Council on Addiction Psychiatry, told Psychiatric News. “The problem, however, is getting physicians more comfortable prescribing [buprenorphine], since there are already many physicians who are certified but don’t prescribe or underprescribe (Psychiatric News, March 18).

“Training physicians while they are residents is a very good strategy,” she said. “We need a grassroots approach.”

Her comments were echoed by John Renner, M.D., vice chair of the council. “Our survey of addiction clinicians indicates that the majority are not comfortable treating numbers of patients in [the 150 to 200 patient] range,” he told Psychiatric News. “It is possible that this change will create a number of large buprenorphine practices, but it will not generate the numbers needed to impact the current epidemic. We remain committed to our proposal to expand treatment services by also encouraging a larger number of small buprenorphine practices by expanding clinician training, permitting prescribing by physician assistants and nurse practitioners, and addressing clinicians’ concerns about the system of DEA inspections.”

Also speaking at the summit in Atlanta was psychiatrist Patrice Harris, M.D., M.A., who is chair of the AMA’s Task Force to Reduce Opioid Abuse. As part of her remarks, she encouraged physicians to use state Prescription Drug Monitoring Programs.

“We urge physicians to register and use the state prescription drug monitoring program to check a patient’s prescription history; educate yourself on managing pain and promoting safe, responsible opioid prescribing; support overdose prevention measures, such as increased access to naloxone; reduce the stigma of substance use disorders and enhance access to treatment; and ensure patients in pain aren’t stigmatized and can receive comprehensive treatment.” ■