Addiction specialists report growing struggle to meet demand for medication treatment

Addiction specialists surveyed by the American Society of Addiction Medicine (ASAM) appear more strained to meet demand for medication treatment for opioid addiction today than they were just two years ago. The results of the survey of more than 1,300 physicians will lend momentum to ASAM's continued interest in seeing relaxed federal restrictions on the number of buprenorphine patients any individual physician can treat at one time.

The latest survey, results of which were released last month, found that 66.3% of physicians waivered to prescribe buprenorphine say there is patient demand for treatment that exceeds their 100-patient limit. When addiction specialists were asked the same question in a 2013 survey, only 41.5% said at that time that demand was outpacing the 100-patient limit.

Also, a growing percentage of ASAM physicians are now maintaining a high buprenorphine patient load of more than 80, according to the survey., This was the case for 45.3% of surveyed physicians in 2015, compared with 37.1% of those surveyed in 2013.

ASAM conducted and released the survey in anticipation of the Department of Health and Human Services' (HHS's) plan to revise federal regulations governing buprenorphine prescribing that have been on the books for more than a decade. Comments submitted by physicians visiting ASAM's website to read the survey results indicate their keen interest in seeing the 100-patient limit relaxed or eliminated. Here are some of their comments:

• “The 100 limit is unprecedented in other disease states and it contributes to the counterproductive stigma of addiction.”

• “With this disease, a waiting list is a tragedy.”

• “A 250-patient limit is a safe start. There are not enough waivered physicians to give this much-needed care.”

• “I watched the eyes of a senior resident at our team meeting today and her sadness at our triage process which consists of turning away patients.”

One commenter did add a noteworthy caveat, however, writing that any increase in the patient limits “should be limited to those physicians who accept Medicare and Medicaid so that the 'pill mills' can't profit from the increase. It might make more physicians morally responsible treating this disease.”

The latest survey also showed an increase from 2013 in the percentage of overall respondents who are waivered to prescribe buprenorphine. Only 8.1% of the 1,309 respondents to the 2015 survey do not have the federal waiver, as opposed to 10.8% of the 458 respondents to the 2013 survey.

Physicians are subject to a 30-patient limit in their first year of prescribing buprenorphine, after which the maximum is increased to 100.