President Barack Obama's administration on Tuesday advanced what may seem like a small, technical fix but is potentially a big deal to victims of America's opioid painkiller and heroin epidemic.
Specifically, the White House said it will propose a rule to increase the patient limit for qualified doctors who prescribe buprenorphine, which is used to treat opioid abuse, from 100 to 200 patients. In short, this should allow doctors to prescribe the potentially lifesaving medication, also known as Suboxone, to many more patients.
It's a desperately needed change at a time when opioid deaths and abuse remain very high, with 29,000 overdose deaths linked to opioids in 2014. The rule change should go into effect after 60 days of public feedback.
Along with raising the cap, the White House will also unlock more than $100 million in funding to boost medication-assisted treatment in federally funded community health centers and up to 11 states. The administration will also take other steps, including the establishment of a task force focused on opening access to care for mental health and substance abuse issues. (You can see the full approach here.)
These are just the latest steps taken by the Obama administration, which has proposed a broader plan to deal with the opioid crisis. But this latest proposal specifically targets a form of treatment proven to help combat opioid abuse.
The science behind medication-assisted treatment
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Buprenorphine is a medication used to manage and treat someone's opioid abuse. It's also an opioid, but it's much more difficult to abuse than heroin or traditional painkillers. When taken as prescribed, buprenorphine can eliminate someone's cravings for opioids and withdrawal symptoms — to help avoid relapse — without producing the kind of euphoric high that heroin or traditional painkillers can.
Buprenorphine is similar to methadone, another opioid used to treat opioid addiction. But buprenorphine is offered in take-home doses, while methadone is, for people with drug abuse disorders, usually administered once a day in a clinic.
These two drugs, used in what's known as medication-assisted treatment, have been well vetted: Decades of research have deemed them effective for treating drug abuse. The Centers for Disease Control and Prevention, National Institute on Drug Abuse, and World Health Organization all acknowledge their medical value.
But access to medication-assisted treatment remains sharply limited, in part due to the patient limit on buprenorphine. A 2015 study published in the American Journal of Public Health found that nearly 1 million people could not access opioid medication-assisted treatment — an estimated 2.3 million abused or were dependent on opioids in 2012, while just 1.4 million could obtain medication-assisted treatment.
The reason for the cap is a concern that buprenorphine, like other opioids, could be diverted to the street market and abused if it's made too easily available. But to this end, the cap can be self-defeating: A 2012 study in the journal Drug and Alcohol Dependence concluded that a big contributor to the abuse of diverted buprenorphine was lack of access to affordable buprenorphine treatments for opioid abuse.
A more philosophical argument against medication-assisted treatment is that treating opioid abuse with medications like buprenorphine or methadone is simply replacing one drug with another. But this seriously misunderstands the nature of drug abuse; the issue is not whether a patient is using a drug, necessarily, but whether the patient is taking a drug in a way that puts his or her life in danger. Since buprenorphine and methadone are proven to reduce the risk of overdose death and abuse when taken as prescribed, they address the core issue with addiction.
The White House, for its part, clearly sees value in medication-assisted treatment. So it's boosting access to it in an effort to combat one of the biggest public health crises of the past several decades.
To learn more about the opioid painkiller and heroin epidemic, read Vox's explainer.
