In response to the new changes announced by the U.S. Department of Health and Human Services (HHS) to stop opioid addiction, Baltimore City Health Commissioner Dr. Leana Wen held a conference on July 6th. The commissioner expressed a deep satisfaction and optimism towards the new regulations from the HHS, and went on to praise the Centers for Medicare and Medicaid Services (CMS) for their proposed adjustments as well. Through their combined efforts, Wen sees new and expansive tools to stop opioid addiction in the city of Baltimore.
The HHS changes Wen referred to were made to its “Buprenorphine Final Rule”, a national law which places strict limitations to the number of patients that a health practitioner may prescribe buprenorphine to. Buprenorphine (suboxone) is a narcotic used to control opiate addictions. It works by operating on the mu receptor, a part of the brain thought to control sleep, respiratory functions, and emotional behavior.
Treating opiate addiction in Maryland is a very stringent process that has been made even more difficult by the Buprenorphine Final Rule, a law originally designed to help addicts get clean faster. Under this law, if a physician can pass an 8-hour educational course (and meet other similar requirements), then they can apply for a waiver to treat addictions in an office environment. While most find this portion of the law to be agreeable, the controversy is over a different clause does not allow the physician to treat more than 30 patients at any given time for addiction during their first year of practice. After a year, the cap is increased to 100 patients.
The problem with this law is that it artificially limits the amount of addicts that a physician can treat, even if the physician is perfectly capable of helping far more people at once. As Wen points out, cities like Baltimore, where heroin claimed 578 Maryland lives last year, cannot afford to have physicians with their hands tied behind their backs. One has to question how many lives could have been saved with a higher cap on buprenorphine prescriptions.
Wen reminded attendees that she testified before Congress and before the House Oversight Committee to support the elimination of caps on buprenorphine prescriptions, pointing out that no other medicine has ever had these sorts of limitations placed on them. The HHS agreed and expanded the number to 275 patients this month, a nearly 200 percent increase.
The commissioner went on to laude the CMS for its recent national changes to the pain management surveys that are given to hospital patients. A few questions in particular asked patients to rate how satisfied they were with the hospital’s ability to manage their pain, which critics felt could influence hospitals to overuse painkillers so as to avoid negative reviews, which could cost them future grant money. Known as the Hospital Value Based Purchasing Program, hospitals could hypothetically be rated as lower quality due to an addict who was not satisfied with the amount of painkillers they received. Under the new surveys, these questions have been eliminated completely.
The commissioner used recent statistics to remind attendees that the city of Baltimore still has a long way to go before they can overcome opiate addiction. In 2014, the 578 lives lost to heroin was a 25 percent increase in Maryland overdoses than in 2013, and it was also more than double the number of people who died from heroin in 2010. Although the city of Baltimore is still struggling in the midst of a heroin epidemic, these two revised measures from the HHS and CMS will give health physicians the necessary permission to use all of their available tools.