For Immediate Release: October 14, 2015
Contact: Gretchen Andersen 202.225.2301
 
Washington, D.C. – In the midst of our country’s rampant prescription drug abuse and opioid epidemic, Congressman Tim Murphy (R-PA) and 12 members of Congress sent a letter to Health and Human Services Secretary Sylvia Burwell calling for a comprehensive review of buprenorphine clinic operations, outcomes and practices, and to improve the availability and access to the full spectrum of treatment options. 

The congressional letter comes in response to the recent HHS announcement that it intends to change current limits for prescribing the synthetic opioid buprenorphine. Used as a method for those addicted to heroin and prescription painkillers, buprenorphine is the main staple of the federal government’s medication-assisted treatment program (DATA 2000). Currently, participating doctors are capped at 30 addiction patients and can request authorization to prescribe for up to 100 addiction patients after one year. The new rule would allow doctors, with no additional training or oversight to prescribe buprenorphine beyond the current 100 patient cap. 

This change opens the door to expanded diversion (the unlawful channeling of physician prescribed pharmaceuticals to the illicit marketplace) of buprenorphine. Under the current cap of 100 patients the illicit use of buprenorphine has climbed and it is now the third most diverted prescription opioid. With an unchecked increase in access to prescription opioids, like buprenorphine, there will be an increase in abuse. 

“Prescription drugs help to stabilize the patient, but they do not sufficiently ensure treatment effectiveness and success. If you are considering increasing the DATA 2000 patient limit, we strongly encourage you to better study and understand the quality and effectiveness of the treatment these practices provide,” stated the members.

Murphy submitted a copy of the letter as part of the record at the Energy and Commerce Subcommittee on Health hearing “Examining Legislative Proposals to Combat our Nation’s Drug Abuse Crisis.” As Chairman of the Oversight Subcommittee, Murphy has lead a series of investigative hearings examining the national opiate crisis both in Washington and at the local level, bringing in clinicians and experts from public service, academic and research centers. The Oversight Subcommittee's findings demonstrate that traditional methods of dealing with individuals with addiction have not been effective. Moreover, the overprescribing and inappropriate prescribing of opioids has a significant connection to the alarming increases in opioid addiction and overdose deaths for more than a decade; it has also fueled the increased use of heroin.

The letter specifically urges HHS to mandate that buprenorphine providers offer opioid addicted individuals the full range of approved opioid treatment medications along with counseling, substance use monitoring and diversion control before any consideration is given to lifting the Drug Abuse Treatment Act of 2000 patient cap.

A copy of the letter can be viewed below.

The Honorable Sylvia Mathews Burwell 
Secretary 
U.S. Department of Health and Human Services 
200 Independence Ave, SW 
Washington, DC 20201 

Dear Secretary Burwell: 

As you know, there is a rapidly growing opioid abuse epidemic in our nation and the need for comprehensive treatment has never been greater. Data from SAMHSA’s 2013 National Survey on Drug Use and Health shows that 1.9 million people in the United States suffered from substance use disorders related to prescription opioid pain medicines in 2013 and 517,000 suffered from a heroin use disorder. The number of unintentional overdose deaths from prescription opioids has soared in recent years, more than quadrupling since 1999. Despite the increasingly high rate of opioid abuse and significant need for treatment, existing evidence-based comprehensive treatment strategies that move people from opioid maintenance and into full recovery are highly underutilized. Some have called for relaxing federal law to allow physicians in Drug Addiction Treatment Act of 2000 (DATA 2000) practices, which are not required to use or offer comprehensive services, to increase the number of patients they see as a means to increase access to opioid addiction treatment. However, we know very little about the DATA 2000 waivered practices, how many patients are in them, what treatment services they receive, how long they stay in treatment, and how often they use illicit opioids or divert the buprenorphine that is prescribed to them. Moreover, an HHS study which appeared in the American Journal of Public Health last month found that nationally only half DATA-waived physicians are listed on the buprenorphine treatment locator.  This suggests that DATA 2000 physicians who can see more patients are not actively seeking to do so.   

The evidence makes clear that prescription drugs alone is not the answer. Prescription drugs help to stabilize the patient, but they do not sufficiently ensure treatment effectiveness and success. If you are considering increasing the DATA 2000 patient limit, we strongly encourage you to better study and understand the quality and effectiveness of the treatment these practices provide. As such, we ask that you measure: 

• The number of patients in treatment within each DATA 2000 practice relative to its cap;
• The percentage of practices providing counseling on-site and the corresponding number of patients in each practice who utilize those services;
• The percentage of physicians referring patients for counseling off-site and the corresponding number of patients in each practice who utilize those services; 
• The percentage of practices providing toxicology testing to guide therapeutic dosing and decision making;
• The percentage of toxicology tests for illicit opioids that are positive;
• The percentage of other illicit drug use in DATA 2000 practices;
• The percentage of patients in DATA 2000 practices that are divert their buprenorphine (for resale or other illicit use).The dropout rates in DATA 2000 practices. What percent of DATA-waivered practices;
• The relapse rate after drop out of DATA 2000 practices
• The extent to which DATA 2000 practices successfully wean patients off of buprenorphine and on to opioid antagonist medication and relapse prevention counseling;
• What percentage of patients are enrolled in multiple DATA 2000 practices (that is, filling prescriptions from multiple practices); 
• What percentage of patients are taking their prescriptions for buprenorphine to multiple pharmacies; and
• The dosing regimens for buprenorphine in DATA 2000 practices, and its association with buprenorphine diversion.

Further, to ensure that patients seeking care at DATA 2000 practices receive the type of care that has proven to be most-effective, we ask that you adopt the following MAT-based reforms at these practices:

• Inform patients of their treatment options and the availability of non-addictive FDA-approved treatments and counseling;
• Review all FDA-approved treatments options, and obtain informed consent to treatment selected;
• Report to HHS on patient length of treatment stay, dropout rates, and drug use in past 30 days prior to discharge;
• Report on the average buprenorphine prescription length (e.g., one week, 30 days, etc.); 
• Conduct a minimum amount of counseling per patient, per month;
• Employ prescription drug diversion control strategies;
• Perform drug testing to make sure patients are taking their prescribed medications, are not using illicit drugs, and to guide treatment decisions (e.g., increase or decrease intensity);
• Use Prescription Drug Monitoring Programs to ensure patients are not getting opiates elsewhere;
• Provide each patient with a comprehensive ASAM Patient Placement Assessment;
• Develop individualized treatment plans based on their assessment, including relapse and overdose prevention;
• Monitor the patient’s response to treatment, using toxicology tests and patient self-report, and make changes to the patient’s treatment plan, when indicated by lack of treatment response, treatment failure, or the patient’s desire to become opioid-free;
• Implement an active medication diversion control plan, including medication checks.

We do not believe that simply allowing DATA 2000 physicians the ability, whether acted upon or not, to prescribe more opiates to patients by increasing the patient cap is a solution. Doing so runs the risk of allowing more physicians to prescribe more opioids, without providing patients with the comprehensive and coordinated care necessary for effective treatment as described by HHS’ own treatment guidelines in TIP 40. We agree strongly that there is a need for more quality treatment, which includes a full range of treatment options, including support for becoming opioid-free with the help of detoxification and relapse prevention medication assisted treatment. Only by safely reducing the number of people who are using opioids inappropriately will we reverse the current epidemic. We further ask that you work closely with the Congress before any action is taken in this area. 

Thank you for your consideration. 

Sincerely,

Rep. Tim Murphy

Rep. Lou Barletta 

Rep. Dan Benishek 

Rep. Steve Chabot 

Rep. Daniel M. Donovan Jr.

Rep. Frank Guinta 

Rep. Richard Hanna  

Rep. Richard Hudson

Rep. David B. McKinley 

Rep. Keith Rothfus 

Rep. Steve Stivers 

Rep. Ryan Zinke

Rep. Cathy McMorris Rodgers

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In his seventh term representing Pennsylvania’s 18th congressional district encompassing suburban Pittsburgh including parts of Allegheny, Washington, Westmoreland and Greene Counties, Rep. Tim Murphy also serves as a Commander in the Navy Reserve Medical Service Corps as a psychologist treating Wounded Warriors with post-traumatic stress and traumatic brain injury.