By Adrienne Standley
In the midst of a tragic overdose crisis, in the state with the third highest rate of overdose deaths in the country, and as we mourn more than 4,200 lives lost in our state last year to drug overdose, restricting access to life-saving addiction treatment seems counterintuitive—doesn’t it?
It should, yet a Senate-approved bill now before the House Human Services Committee seeks to limit physicians’ ability to prescribe the life-saving medication buprenorphine, restricting its use and creating an additional barrier to getting treatment to patients with opioid use disorder.
The legislation sponsored by Senate Health & Human Services Committee Chairwoman Michele Brooks, R-Mercer, would make a treatment medication that’s already heavily regulated and difficult to obtain even harder to access for patients.
Misinformation ran rampant in the Senate as a hearing on Brooks’ bill took place earlier this summer, and, sadly, it’s somewhat understandable.
Substance use disorders, drug use in general, and treatment methods are complex issues that are often misunderstood. Below, we’ll outline some of the misconceptions as well as discuss the terrifying and deadly potential ramifications of a bill such as this one.
First, everyone should understand a few things about the treatment being discussed.
The experts brought in for the Senate hearing in June (neither of whom were licensed physicians, licensed to prescribe medication, or licensed to treat addiction) stray far from the mainstream of addictions research and perpetuated the incredibly incorrect narrative that buprenorphine is being diverted and “abused” like an illicit opioid.
Buprenorphine is a maintenance medication considered widely as a “gold-standard” treatment for opioid use disorder. It is recommended by the CDC, the World Health Organization, the American Society for Addiction Medicine, the U.S. Surgeon General, and more.
It is a unique molecule known as a partial opioid agonist—meaning it operates differently than a traditional opioid. It cannot be misused to obtain a “high” by those with an opioid tolerance, and cannot cause overdose.
Because it is a partial agonist, it has a plateau effect, which means that unlike traditional opioids (either prescription or illicit), it will not cause an overdose even if taken in a large quantity.
Buprenorphine is simply a medication that is used either to aid in detoxing a patient from opioid dependency or as a maintenance medication to curb cravings and assist patients in maintaining recovery or stability.
Access to this life-saving medication is already limited in Pennsylvania because of existing restrictions set in place by the nation and the state.
In Pennsylvania, providers who wish to offer this treatment must undergo a training and receive a special waiver, and the number of patients they’re permitted to treat is limited.
Even providers who are licensed to prescribe prescription opioids, such as Vicodin and OxyContin, must opt to undergo additional training to obtain a waiver to prescribe the treatment for the dependence and misuse of those exact opioids.
Speaking to providers in the field, this means that doctors who seek to offer this service may often essentially only do so part-time because of patient limits.
In fact, with only 4 percent of physicians in the United States waivered to prescribe buprenorphine, the need already far exceeds the scarce number of providers.
Brooks’ legislation seeks to add an additional fee and additional barriers—these additional and duplicative certifications and restrictions are not needed.
To save lives during an overdose crisis in Pennsylvania and ensure we are getting treatment to those who are seeking it, we at We The People strongly recommend expanding access to buprenorphine, not restricting it.
Despite the false information presented during the first Senate hearing, there is indeed already a method to track whether or not a patient has already been prescribed buprenorphine—the PDMP (Prescription Drug Monitoring Program).
This is a safeguard to ensure that patients are not given duplicate prescriptions, which serves to limit diversion or over-prescribing of the medication.
In addition, it is important to understand that diversion of a treatment medication actually shows not that people are misusing the drug, but that they are frustrated by lack of of access to it.
As an outreach worker, I occasionally see diverted buprenorphine—those selling it are doing so because they struggle with economic insecurity (low wages, lack of employment, eviction, homelessness), and those purchasing are doing so because they struggle to otherwise access the treatment.
If we want to decrease diversion, cutting off access is clearly not the solution. We should ensure that those who are ready for treatment are able to access it themselves.
Currently, we have six counties in Pennsylvania with no physician certified to prescribe buprenorphine and six others that have only one. When a person makes the decision to seek treatment, we should be ensuring that effective, evidence-based treatment is readily available.
On top of already limited access, there is also an additional factor that could threaten the safety and stability of thousands of people in recovery.
I spoke to Kevin Moore, director of Care Coordination at Accessible Recovery Services Treatment Centers, the largest medication assisted treatment provider in the state.
What he laid out for me in terms of how this bill could impact their patients was truly upsetting. Buprenorphine, being a maintenance medication, is indicated to be prescribed for up to a year. There is word that the House Human Services Committee has discussed adding to this bill a prescription cut-off of three months—far shorter than the recommended timeframe for use.
Brooks’ bill could become even more dangerous if this provision to immediately cut off patients currently receiving the medication is added to it.
At Moore’s organization, there are 15,000 patients across the state who are currently in treatment for a Substance Use Disorder using such medically assisted treatment as buprenorphine.
If this bill were to pass with the prescription cut-off amendment, it would immediately kick many of these patients off their current, doctor-recommended treatment plan, disrupting their lives and putting them at incredible risk for relapse and overdose. When talking to Moore about the potential for this immediate disruption in treatment, he put it simply: “it [SB 675] would be awful, people would die. People would absolutely relapse and die.”
In the midst of a tragic overdose crisis, let’s ensure the safety of those in recovery and open up new opportunities for those interested in accessing treatment and recovery.
We must trust doctors, prescribers, and experts in the field. If we want to stem the tragic tide of overdose deaths in this state and reduce the numbers of people misusing drugs, we need to expand access to buprenorphine, not limit it.
Brooks’ bill is not only misinformed, it is cruel—and it is deadly.
Adrienne Standley is the Deputy Outreach & Engagement Director for We The People – Pennsylvania, a project of the Pennsylvania Budget and Policy Center, a progressive think-tank in Harrisburg. She describes herself as a ‘harm reductionist’ in Philadelphia.