Doctors who treat opioid addiction with medication like Suboxone soon will be able to treat more patients, a change the federal government is hoping will help ease the shortage of treatment options for the opioid epidemic ravaging the country.
President Barack Obama will announce the proposed rule change at the National Rx Drug Abuse and Heroin Summit in Atlanta today.
Currently, doctors must be specially certified to prescribe buprenorphine-based drugs, like Suboxone and Bunavail, which are used in conjunction with counseling to treat opioid addiction. Once certified, a doctor can treat only 30 patients in the first year and 100 patients after that.
The new proposed rule would raise that limit to 200, doubling the number of patients each doctor could treat with buprenorphine.
Sylvia Mathews Burwell, the U.S. secretary of Health and Human Services (and a native of Hinton), announced last fall that the limits would be changed, but the specific number had not yet been disclosed.
Nearly 650 people died of drug overdoses in West Virginia last year, and lack of available treatment is a persistent problem.
Dr. Tom Reach runs seven buprenoprhine clinics in Tennessee, Virginia and North Carolina.
He said he has about 300 patients who travel from West Virginia to his clinic in Abingdon, Virginia, for opioid treatment.
"It's a good step in the right direction," Reach said of the increased limits. "This will dramatically help."
But Reach, who estimated that there are only enough buprenorphine-certified doctors to treat 40 percent of patients, said he was hoping for an even greater increase in the patient limit. He noted that no other area of medicine is limited in such a way.
"In light of this incredible epidemic, where people are dying, they're only going to let board certified specialists, who know what they're doing, treat 200," Reach said. "Addiction is a disease, it should be treated like any other disease."
In West Virginia, where buprenorphine or "bupe" is often sold as a street drug, the Legislature recently passed a bill (SB 454) to regulate clinics that dispense the drug.
That bill, which was requested by Gov. Earl Ray Tomblin but still awaits his signature, requires Suboxone clinics to offer counseling in conjunction with treatment and to drug test their patients, to ensure that they are using the medication as intended.
It also allows the state to regularly inspect such clinics and requires them to collect and submit data on their performance.
There are 167 doctors in West Virginia certified to prescribe Suboxone, according to the state Department of Health and Human Resources.
Obama also will announce today that more than 60 medical schools, including West Virginia University and Marshall University, will, in the fall, require their students to be taught opioid prescribing practices in line with new federal guidelines.
Earlier this month, the federal Centers for Disease Control and Prevention announced new guidelines for prescribing opioids.
The new practices include looking for other treatment options first, prescribing the lowest possible dosage, reviewing a patient's history with controlled substances and evaluating the benefits and harm of the treatment.
Students at the participating medical schools will be taught those guidelines.
Obama, in an October interview in Charleston with the Gazette-Mail, noted how little education doctors get in prescribing opioids.
"What we've discovered is that the medical community - not out of malice, but I think out of carelessness - tends to over-prescribe or not manage their patients' pain medications as carefully as they should," Obama said. "One interesting statistic: For the thousands of hours that medical students and residents put in, in order to become a certified doctor, they spend about 11 hours, their entire academic career, studying pain medication.
"Well, what that really means is that they may be a great surgeon, they may be a great internal medicine specialist, but if the patient comes in and says 'I'm hurting,' they're just writing a prescription without really figuring out what's best for that patient, and how do we avoid addiction."
Dr. Carl Sullivan, who runs the addiction program at West Virginia University Medicine, said the increased focus on addiction is much needed.
"Most physicians just don't know anything about addiction," Sullivan said. "There's still a lot of - I hate to say ignorance, because it makes them sound stupid - but they just don't know."
Reach David Gutman at david.gutman@wvgazettemail.com, 304-348-5119 or follow @davidlgutman on Twitter.