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Limiting Treatments Unethical

This past summer, the Obama administration tripled the cap on the number of opioid-addicted patients that an authorized physician can treat with buprenorphine/naloxone (Suboxone), a drug that eases the effects of withdrawal from prescription opioids and heroin and markedly decreases the chances for overdose and death.

What are patient caps? In 2000, Congress passed DATA-2000, a law that allows authorized physicians to become eligible to prescribe such medications as buprenorphine specifically for the treatment of opioid addiction. This law arbitrarily capped the number of patients a certified physician could treat to 100 a year, beginning in the first year with 30 patients. This was expanded this summer to 275 patients.

This new cap not only defies logic, but is unethical. No other medications, including the ones that cause addiction, have such harsh limits, especially since there are no evidence-based studies that support a cap at any level. Almost 3 million people in the U.S. are diagnosed with opioid abuse disorder, with the rate of deaths from overdose increasing by 200 percent since 2000. Look at the trajectory.

The number of opioid prescriptions more than doubled between 2000 and 2012, when more than 282 million prescriptions were written. The number of medical services such as office visits and lab tests for patients with a dependency diagnosis rose from 217,000 in 2007 to 7 million in 2014, a 3,000 percent increase. And, when the DEA had its chance this past spring, it failed to impose limits on Big Pharma’s production of opioids.

There are about 800,000 physicians in the United States, but only 32,000 have taken the required eight-hour course to qualify. For those who actually qualify, the federal government then imposes these caps on the number of patients they can treat each year. The combination of caps and low physician participation results in almost no access for many patients.

Limiting medication-assisted addiction treatment while not limiting the source of addiction essentially promotes addiction. Sure, states are beginning to set limits on the volume of prescriptions physicians can write for patients, but this is like emptying the ocean, one teaspoon at a time.

Frankly, the cap disproportionately affects the poor. The age-old law of supply and demand is alive and well. The caps lower supply and addiction overdoses have increased demand in every community in our country. Physicians can opt out of insurance and demand cash, sometimes as much as $500 per office visit, because of yearlong patient waiting lists. The cap leaves little incentive for physicians to lower rates or to become experts in medication-assisted treatment of opioid dependency.

Buprenorphine, when combined with therapy, has been proven effective and is considered the standard of care. It is unconscionable to ration this lifesaving treatment while the CDC reports that 78 people die each day from opioid overdose. This reason alone should be enough to lift the cap.

Studies have shown that opioid addiction is a chronic brain disease to which some people are genetically predisposed. Recovering addicts who do not manage their dependence with medication are significantly more likely to relapse into illicit drug use and overdose.

Can you name another chronic condition in our medical lexicon where we ration medically necessary treatment, especially when treatment has been proven to lessen the chance of death? Our legislators need to do the math and break out of their political malaise. Families and communities don’t have time for incremental tweaking of the edges of 15-year-old laws. A bold stroke of the pen is necessary. In this crisis, time does not cure all ills. It kills.

Susan M. Mathews, of North Hutchinson Island, Fla., is a registered nurse and holds a master’s degree in bioethics from Union Graduate College.

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