Two bills in Pa.’s legislature would place restrictions on medication-assisted treatment for addiction

A bill that would require doctors to register with the state before they can prescribe the opioid-based addiction medicine buprenorphine passed the Pennsylvania Senate this week.

But some addiction doctors have criticized the bill, Senate Bill 675, because doctors who want to prescribe buprenorphine already have to take a special course and register with the federal government.

The current federal restrictions, advocates say, have been enough to deter many doctors from prescribing buprenorphine, which, like other opioid addiction medications, has been shown to give patients a better shot at recovery.

“We’re in an opioid crisis, and what we need is for patients to access treatment. And anything that creates a barrier to access treatment is going to mean more people not getting treated," said Frederic Baurer, head of the Pennsylvania Society of Addiction Medicine (PSAM) and the medical director of the Kirkbride Center, an addiction treatment center in Philadelphia.

“Many doctors are already reluctant to treat addicted patients, and they certainly are not going to be encouraged to do so by bills that either require them to pay a fee or to do more administrative paperwork or to answer to a state agency above the certification requirements for office-based opioid treatment," he said.

The bill would require doctors looking to prescribe the drug to pay a certification fee of up to $500 to the state Department of Drug and Alcohol Programs. It would also require patients to prove they were actively participating in a state-licensed addiction treatment program before receiving the drug.

It was introduced after Pennsylvania weathered another year of some of the highest overdose death rates in the country. More than 5,400 Pennsylvanians died of overdoses in 2017. Estimates in 2018 were closer to 4,200 overdose deaths — a drop of about 22 percent, but still a staggering number, officials have said. Philadelphia saw 1,217 overdose deaths in 2017 and 1,116 fatal overdoses the following year.

The bill was sponsored by State Sen. Michele Brooks (R., Erie), who floated a similar bill that failed to pass last year. After the new bill passed the Senate by 41-9 this week (with two Philadelphia state senators, Larry Farnese and Vincent Hughes, voting against it), it was referred to the state House of Representatives’ Human Services Committee.

At a news conference Tuesday, Brooks said the legislature has “ignored the growing need for additional state oversight of that treatment.” She said that because buprenorphine is itself an opioid, it needs to be more heavily regulated to “end abuse and diversion of Suboxone,” a brand-name version of buprenorphine that also includes the overdose-reversing drug naloxone.

“We recognize that this drug can be part of an effective treatment plan when used properly,” Diane McNaughton, Brooks’ chief of staff, wrote in an email, but said black-market trafficking of the drug continues.

She noted that the legislation is supported by the Drug and Alcohol Service Providers Organization of Pennsylvania, a coalition of several hundred state-licensed treatment providers.

But Baurer said that people in active addiction who seek out “diverted” Suboxone on the street are often looking to help diminish the painful symptoms of withdrawal, not to achieve an enjoyable high.

“It’s not that you can’t get high on Suboxone — if [a person unused to opioids] took it, you would get an opioid effect,” he said. “But if you’re addicted, you’re not looking for Suboxone to get high. People are using it to alleviate their symptoms and sort of treat themselves. Denying people treatment because some people are going to divert or sell it is not helping.

“There’s an overdose epidemic — there are a lot of opioids that have contributed to causing the epidemic, but Suboxone is not one of them," he continued. "And diversion occurs with pretty much any controlled substance.”

Baurer’s organization also raised concerns about a second bill — which is still in committee in the state House — that would require people starting on medication-assisted treatment (MAT) to undergo at least 2½ hours of therapy a month at a state-licensed treatment facility for a year. The bill also includes shorter therapy requirements for people receiving MAT for up to four years.

It would also require doctors eventually to wean their patients off the medications, although it said the state can allow some patients to obtain waivers to stay on MAT.

State Rep. Kerry Benninghoff (R., Centre), who sponsored the bill, said he had toured the state hosting forums on addiction over the last year, and was concerned about people who take MAT for long periods of time.

“All you’re doing is trading one drug for another. Our goals should be getting people to recovery,” he said. Advocates say that attitude is a common stigma against medication-assisted treatment, and that many people go about their daily lives for years on medications like Suboxone.

“Addiction is not an acute illness, but they’re trying to make me treat a chronic disease as if it were an acute illness,” said William Santoro, PSAM’s public policy chair and the chief of addiction medicine at Tower Health System in Reading. “I don’t see any reason why you have to stop using medication if you need it.”

Benninghoff said he was open to suggestions on the bill and to holding a public hearing; he said he wasn’t looking to rush a vote. “We have all summer to try to get a hearing on it,” he said.

Santoro said he doesn’t believe state lawmakers should “dictate how doctors actually perform their job.”

“Based on evidence-based practices of what we need, let doctors do what we do, and if a particular doctor isn’t doing it well, then he or she should be sanctioned,” he said.