Comments on Proposed Legislation to Eliminate 30-Patient Limit for Buprenorphine Prescribing (NEW:May 11'04)
By Robert Newman, MD

Two bills (Senate 1887, House 3634)have been introduced to eliminate the current limit of 30 patients that can be treated by group practices with Buprenorphine. Neither would alter the 30-patient limit on any individual physician, whether practicing solo or in a group. Both limits – on the group practice and on the doctor – are without precedent, and would seem to reflect the bias of Government against the disease of addiction, the patient, the provider and the treatment.

In fact, the illogic of both the current and proposed legislation is worse than meets the eye. Doctors actually are free to have as many opiate-addicted patients as they wish; the congressionally-mandated constraints apply not to the number of addicts that can be treated, but to the choice of treatment! For instance, a clinician treating HIV-AIDS is not challenged if 200 of his/her patients are known to be opiate-dependent. Only 30 of them, however, can be prescribed Buprenorphine.

The stated goal of the American authorities to "mainstream" the treatment of opiate addiction will not be achieved until laws and regulations reflect evidence-based medicine, rather than politics and fear. Dictating by legislative fiat which medicines can be prescribed, and to how many patients, will continue to discourage physicians from treating addiction. Meanwhile, many hundreds of thousands of opiate-addicted individuals remain without help or hope.

P.S. As of 10 May 2004 the House bill was referred by the Judiciary Committee to the Subcommittee on crime, terrorism and homeland security. Medical practice restrictions whether imposed or eased by a congressional committee on crime, terrorism and security, surely convey a message that conflicts with the avowed intent to "mainstreaming" the treatment of addiction!




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