As the opiate addiction crisis deepens in Vermont and across the U.S., expanding access to treatment is becoming a national priority.
The number of people who reported using heroin for the first time nearly doubled between 2006 and 2012, according to the National Institute on Drug Abuse. In Vermont, the number of people seeking treatment for opiate addiction increased 40 percent from 2014 to 2015.
Despite efforts to expand treatment in the Green Mountain State, more than 200 people are on waiting lists for opiate treatment statewide. Many more have given up on finding a slot in a treatment program, providers say.
In his State of the Union address, President Barack Obama said he hopes to see bipartisan action in Congress in the final year of his term aimed at “helping people who are battling prescription drug abuse and heroin abuse.”
That was likely welcome news for a coalition of treatment providers in Vermont eager to see a change in federal law that they say could greatly reduce the number of people waiting for treatment.
Currently, federal law limits the number of patients that physicians can treat with drugs like buprenorphine, and it prohibits nurse practitioners and physician assistants from prescribing the drugs at all.
Buprenorphine delivers enough opioids to prevent someone from going into withdrawal, but not enough to feel a high. It’s widely recognized as an effective part of recovery from heroin or prescription painkiller dependence once a person is stable enough to be treated in a primary care setting.
Providers say that allowing stable patients currently getting help at intensive outpatient clinics to transition into treatment in a primary care setting would increase the number of new patients who can get into treatment at the clinics, thereby reducing waiting lists.
“We think it’s a missed opportunity,” said Jason Williams, a government relations strategist for the University of Vermont Medical Center, regarding the federal limitations on buprenorphine prescribing.
There are bills in both houses of Congress with bipartisan support aimed at increasing the number of providers who can prescribe medication-assisted treatment drugs like buprenorphine. All three members of Vermont’s congressional delegation are co-sponsors of the legislation in their respective chambers.
“It makes no sense that getting access to drugs to treat opioid and heroin addiction is more difficult than obtaining the addicting drugs,” said Rep. Peter Welch, D-Vt., in an email statement. Currently, nurse practitioners and physician assistants in Vermont can prescribe opiate painkillers.
Gov. Peter Shumlin echoed that sentiment at a news conference in December where he said he would work with the other New England governors to urge Congress to pass the expanded treatment legislation.
The Recovery Enhancement for Addiction Treatment Act would increase to 100 the number of people to whom a physician can initially prescribe medication-assisted treatment drugs; the current limit is 30. After one year there would be no limit on the number of patients a physician can treat with the drugs.
The Senate version, S.1455, was introduced by Sen. Ed Markey, D-Mass., and the House version, H.R.2536, was introduced by Rep. Brian Higgins, D-N.Y.
It would also allow nurse practitioners and physician assistants who are licensed under state law to prescribe federally controlled pain medications to also prescribe the treatment drugs. However, the bill’s language requires that they do so under a physician’s supervision unless they have a subspecialty in addiction medicine.
That’s problematic for Vermont, where licensure for nurse practitioners and physician assistants doesn’t require a supervising physician and most don’t work with direct physician supervision.
Primary care in Vermont is more reliant on midlevel practitioners than the national average, with 77 percent of primary care doctors working with nurse practitioners or physician assistants in Vermont versus 53 percent nationally, according to a white paper on the topic Williams wrote last year.
Williams and a coalition of health care providers and state officials sent amended language that would eliminate the requirement for physician supervision to Vermont’s congressional delegation, urging its inclusion if the TREAT Act moves forward.
An aide for Sen. Bernie Sanders, I-Vt., who is a member of the Senate Health, Education, Labor and Pension Committee — where the TREAT Act currently resides in the Senate — said the senator’s staff is aware of the issue and working to “ensure Vermont benefits from the full impact of the legislation.”
Sanders, who is embroiled in a tight race for the Democratic presidential nomination, has joined candidates from both sides of the aisle in elevating treatment for opiate addiction as a campaign issue.
Still, it’s unclear whether the legislation will gain traction in Congress. Markey introduced the same bill during the previous Congress, but it never made it out of committee. His Senate office did not return a request for comment on the bill’s prospects this time around.
The Senate Health, Education, Labor and Pension committee did hold a hearing on opiate abuse in December. At that hearing, Sen. Lamar Alexander, R-Tenn., the committee’s chairman, called opiate abuse a “growing epidemic.” Alexander said he hoped the committee will take action to address it but did not mention the TREAT Act.
Committee staff said Alexander was traveling Thursday and could not be reached for comment, but an aide provided a statement saying the committee is “working to fashion bipartisan legislation to address mental health and substance abuse issues and we will consider all ideas as we develop a bill to recommend to the Senate.”
