US to Raise Cap for Docs Prescribing Opioid Addiction Drug

[inanna]

Source: Associated Press

WASHINGTON — Jul 6, 2016, 4:02 AM ET

The Obama administration is increasing the number of patients whom doctors can treat for opioid addiction with a medication called buprenorphine.

The cap is being raised from 100 patients per doctor to 275 as the White House tries to pressure Congress to approve funds for opioid abuse treatment. Doctors seeking the higher cap will have to apply.

The modest step being announced Wednesday comes the same day that House-Senate bargainers plan to meet to finalize a compromise package on drug abuse. Both parties have prioritized the issue, but Democratic negotiators are threatening to withhold support unless Republicans agree to add $920 million to finance some programs. The current compromise contains no money.

The White House won't say whether President Barack Obama would sign it if the funds aren't added.

Read more: http://abcnews.go.com/Politics/wireStory/us-raise-cap-docs-prescribing-opioid-addiction-drug-40367580

[brett_jv]

1. Seems fairly reasonable ... 275 ... if you assume 22 work days per month ...

That's what, around 12 or 13 patients per day, assuming most get 1 month of meds at a time and hence visit the doc 1x per month?

Most of the appts are going to be a pee-test administered by staff, then a 5-10 minute checkup with the doc to make sure they're doing their AA or counseling or what-not ... I can see a single doctor handling that patient load okay ... but that's if that's ALL they do.

A number that high should perhaps be an upper limit reserved for docs who's entire business is treatment ... if you also happen to be, say ... a surgeon ... having 275 patients in opioid treatment as well ... that's going to probably involve some shoddy care for those patients.

Be nice if there was $920M also committed to addiction treatment though ... the high up-front costs ($600+ in cash for one's intake appointment is not uncommon ... how many opioid addicts have that kinda money laying about?) along with high ongoing costs (suboxone strips at the pharmacy can go for over $8 each, and some people need 2 or 3 a day, esp. at first ... do the math there) means that MANY MANY people have to elect to try to scrounge up for $10 heroin bags containing dog-knows-what ... every 6 hours instead.

Oh well ... they shouldn't have got their stupid asses addicted in the first place ... right?

[Cooley Hurd]

2. Opioid addiction is a tremendous health crisis now...

...the opioids in question are forms like Hydrocodone, Oxycodone, etc. Legally-prescribed drugs.

[pipoman]

7. The larger problem are the patients who were originally

Prescribed the drugs you mention until they are addicted...then because of the high cost, they end up using herion because it's cheaper.

[Cooley Hurd]

8. It's pretty bad in NYS since the new prescription laws went into effect last yr...

Dr's now have to identity-proof themselves when they prescribe controlled substances, and all scripts (except DME and OTC scripts) have to go electronically. No more paper scripts.

I agree with the law, but NY never put anything into place to directly address the fallout from the law (a lot of already-addicted patients).

[24601]

10. To the contrary all Schedule II medications require a paper-signed script and electronic scripts are

prohibited, other than to alert the pharmacy that a written prescription is en route with the patient. Specially, from the CFR:
"A pharmacist may dispense directly a controlled substance listed in Schedule II, which is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act, only pursuant to a written prescription signed by the practitioner, except as provided in paragraph (d) of this section. A prescription for a Schedule II controlled substance may be transmitted by the practitioner or the practitioner's agent to a pharmacy via facsimile equipment, provided that the original written, signed prescription is presented to the pharmacist for review prior to the actual dispensing of the controlled substance, except as noted in paragraph (e), (f), or (g) of this section. The original prescription shall be maintained in accordance with Sec. 1304.04(h) of this chapter.

http://www.medscape.com/viewarticle/587412

Additionally, Hydrocodone was raised from Schedule III to Schedule II.

So instead of being able to see your pain specialist once every 3 months with electronic script transmission, now it's a requirement to see the Dr. every month to renew a prescription. That's three appointments, with three payments and three times as much time off work needed before the "reforms". Rather than concentrate on the pill-mill docs, the DEA has made it difficult for legitimate doctors to practice anything but defensive medicine.

What government has had a very hard facing is that the clampdown on legal medications in the last 4 years has contributed significantly to the migration to street drugs.

[dixiegrrrrl]

11. Actually, it works a bit differently, and better, for us.

Mr. Dixie has a serious medical issue, and gets opioids every 30 days.
He calls the Dr. office today, for example, and tomorrow a signed script is ready for him to pick up at the Dr. office.
No charge.
He walks the script down the block to the pharmacy, they hand him the meds, he gives them the signed prescription.
Been doing it that way for almost a year now.

Rather than being concerned about an abuse problem, my concern is he is taking less than prescribed, cause he is worried
"they might think I AM abusing them or something"
Thus all this fear talk about people getting to be addicts from their pain meds is actually doing harm in some cases.

[davepdx]

12. Not taking the meds can have serious consequences as well.

If he goes in to see his doctor and has a drug screen done and the resulting measurement is quite low or zero he may well be considered (assumed) to be selling the prescription meds resulting him him potentially losing his prescription and possibly his doctor. Make sure that he is taking his meds prior to seeing his doctor for any reason. My wife is an internal medicine physician who had a patient go on vacation and didn't renew his prescription before he went and he ran out of his pain medication a few days before the vacation ended. When he returned and went to get another prescription he was in severe pain. He was randomly drug tested and because his blood level for the narcotic was zero (because he hadn't taken them for a number of days) he was fired as a patient due to hospital and clinic policy (not my wife's policy). My wife was deeply distressed because she really knew the patient medically speaking and knew that the patient needed the pain relief. The clinic and hospital policy did not provide for any exceptions.

[dixiegrrrrl]

14. Knock on wood, drug testing has not been an issue in our little Mayberry.

Plus, we are both on Medicare, and I suspect docs don't think very suspiciously of "old" people, esp. when the doc is young enough to be my grandson, that young whippersnapper!
Did you know that your average senior citizen sorta of becomes invisible?. Have watched that happen for some years now.

OTOH if I drop my walking stick, 5 people will dive to get it for me, and I don't have the heart to tell them I really don't need it,
it is just a fun game when I go out.

[Cooley Hurd]

13. Not in NYS.

[IronLionZion]

4. Doctors were overprescribing painkillers before

and were being reassured by big pharma that they were safe and not addictive at the prescribed doses. Which turned out to be lies. I think that's why they had caps on these types of drugs.

Some regions, like in Appalachia where a lot of coal miners had been prescribed painkillers, would be having a very high number of their people addicted. It can be hard to treat.

[Jerry442]

3. Charting a course between Scylla and Charybdis.

The Scylla of opioid addiction and the Charybdis of insufficiently treated chronic pain.

Be nice if we had a new class of analgesics that didn't pose such a problem.

[dixiegrrrrl]

5. There ARE drugs that don't pose much of a problem.

Synthetic opioid like drugs, like Tramadol ( Ultram).

What is gonna happen now is the Pharma cartel can make more drugs like Ultram, but charge much much more for it.

Example: Toradol ( ketorolac is the generic name) went from 10.00 for 90 day supply to 115.00 a couple months ago.
And it isn't even an opioid...it is huge dose of Advil type drug and should not be used for more than a few days.

All of this sudden wide spread concern about prescribed opioid use, where Oxycodone is often used in the same sentence as heroin, has me suspecting that Pharma is ready to roll out a solution. An expensive solution at that.

[Jerry442]

6. Pharma is ready to roll out a cheap solution -- said nobody, ever. NT

[haele]

9. Buprenorphine worked for my spouse's psoriatic arthiris and ankylosin sponilosis...however

As it is, Opioids do very little to even take an edge off his pain, unless he takes them in such an amount as to be pretty near non-functional.
He was deathly allergic to Buprenorphine. Swelling and rash allergic - same as his allergy to succinylcholine, a muscle relaxant and nerve calming agent used in anesthesia. So he had 12 hours totally pain free in his life, and then his doctor told him he couldn't take it anymore.
Later he was also part of a genetic test group for a panel of pain medication efficiency; they identified that it as a compound in their panel that would be most effective for the pain, but also identified the side effect component.
They didn't test with cannabis, however - and his experience has been that cannabis works almost as well as the buprenorphine seemed to work on his pain, just not as long.

Haele