In the midst of a tragic overdose crisis, in the state with the third highest rate of overdose deaths in the country[i], and as we mourn more than 4,200 lives lost[ii] in our state last year to drug overdose, restricting access to life-saving addiction treatment seems counterintuitive—doesn’t it?
It should, yet Pennsylvania Senate Bill 675[iii] seeks to limit physicians’ ability to prescribe the life-saving medication buprenorphine, restricting its use and creating an additional barrier to treatment for patients with opioid use disorder (OUD).[iv]
This bill would make a treatment that’s already difficult to obtain even harder to access for patients.
The Pennsylvania Legislature has held two hearings on this bill, with one concluding just yesterday, November 19th. Thankfully, we heard from a wider range of experts opposing this bill, including Secretary of Health Dr. Rachel Levine, emergency medicine doctors, health center providers, and more.
Misinformation ran rampant in the Senate during the first hearing on SB 675 earlier this summer, and, sadly, it’s somewhat understandable. Substance use disorders, drug use in general, and treatment methods for recovery are complex issues that are often misunderstood. We unfortunately heard some of the same questions and misconceptions in the November hearing, so we’d like to take the chance to outline some of the misconceptions as well as discuss the terrifying and deadly potential ramifications of a bill such as SB 675.
First, everyone should understand a few things about the treatment being discussed.
The experts brought in for the Senate hearing (neither of whom were licensed physicians, licensed to prescribe medication, or licensed to treat addiction) strayed 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 American Society for Addiction Medicine, the U.S. Surgeon General, and was added to the World Health Organization’s “List of Essential Medicines.”[v] 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 Rx or illicit) it will not cause an overdose even if taken in a large quantity. Buprenorphine is simply a treatment 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 stability or sobriety.
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.[vi] 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 often may essentially only do so part-time because of patient limits. In fact, it has been shown that with only 4% of physicians in the United States wavered to prescribe Buprenorphine, the need already far exceeds the scarce amount of providers.[vii],[viii] Senate Bill 675 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 treatment to those who are ready, we at We The People strongly recommend expanding access to Buprenorphine, not restricting it.
We already have methods in place to prevent over-prescribing and diversion.
As was reiterated in the second hearing by Secretary Levine, there is indeed already a method to track whether or not a patient has already been prescribed buprenorphine—the PDMP (Prescription Drug Monitoring Program).[ix] This is a safeguard in place to ensure 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. Clearly, diversion is not the most ideal way for people to gain access to needed medication. But it is imperative that we do not see it as a reason to punish those who are selling the medication, but rather as a call for help and improved access by those who are purchasing 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.[x] If we want to decrease diversion, cutting off access is not the solution. We should ensure that those who are ready for treatment are able to access it themselves.
Senate Bill 675 is dangerous from a patient perspective.
Currently, we have six counties in Pennsylvania with no physician certified to prescribe buprenorphine and six others that have only one.[xi] 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, PsyD, director of Care Coordination at Accessible Recovery Services Treatment Centers (ARStc), the largest medication assisted treatment (MAT) 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.
Senate Bill 675 could become even more dangerous if this provision to cut off patients currently receiving the medication is added to it. At ARStc, there are 15,000 patients across the state who are currently in treatment for a Substance Use Disorder (SUD) using MAT such 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.”
Moore was not the only person to make this harrowing statement. In fact, every advocate I have spoken to has said something along these same lines. It was echoed in the November hearing by Dr. Donna Eget who simply stated,
“People will 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. Senate Bill 675 is not only misinformed, it is cruel—and it is deadly.