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Nathan Baker

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Addiction doctors ask for relief from restrictions

June 30th, 2014 9:47 pm by Nathan Baker

Addiction doctors ask for relief from restrictions

U.S. Rep. Phil Roe speaks Monday with addiction specialists at Watauga Recovery Center in Johnson City. (Nathan Baker/Johnson City Press)

Doctors working at the region’s largest addiction treatment center met with state and federal lawmakers Monday in Johnson City to plead for reforms to restrictive laws they say hinder their efforts and put lives at risk.

Addiction specialist Tom Reach spoke with state Rep. Tony Shipley of Kingsport and U.S. Rep. Phil Roe at the Watauga Recovery Center about the group’s efforts to overcome the stigma attached to prescription treatment for opioid dependency and the need for changes to statutes that leave the physicians handcuffed when attempting to treat patients.

The clinic serves 400 patients at the Browns Mill Road location, treating their dependencies with buprenorphine, branded as Subutex and Suboxone.

Because of caps set on certified addiction specialists by the federal Drug Addiction Treatment Act of 2000, limiting them to only treating 100 patients at a time, the center has a four- to six-month wait list, and some patients die of overdose before seeing a doctor, Reach said.

“We have something beneficial here, that really does work, and other doctors are poisoning the well by prescribing it off-label,” he said. “Then, the federal government stepped in, and they ended up creating another problem rather than addressing the original problem.”

The patient limits put the Watauga Recover Center’s Abingdon, Va., clinic in the Drug Enforcement Administration’s crosshairs recently when it lost four doctors.

Instead of shedding 400 patients in various stages of recovery, a clear violation of the Hippocratic Oath, according to Reach, the clinic’s doctors kept the full patient load, knowingly against federal law.

“We couldn’t turn them out on the streets, so we continued to treat them,” he said. “Now we’re being investigated by the DEA.”

Reach said he is communicating with the DEA, an experienced legal team and federal officials on how best to deal with the ethical dilemma.

Buprenorphine, known as Subutex, was created and approved by the Food and Drug Administration to treat dependency on opiates.

By adding naloxone, the drug known as Suboxone deters abuse by injection by making the person injecting it feel sick.

The problem of doctor shopping arose when general practitioners not licensed to treat addiction began prescribing the drugs for pain relief instead of their intended use.

The resulting widespread abuse has led to other negative spinoff effects, like the rise of heroin use and the number of babies in the state born suffering from neonatal abstinence syndrome, or drug withdrawal symptoms.

To combat the epidemic level of prescription abuse in the state, Shipley worked with recovery center staff to sponsor the Opiate Addiction Treatment Act of 2015, otherwise known as “Bella’s Law.”

Under the statute, doctors would be limited to prescribing Subutex and Suboxone for only the uses approved by the FDA, making it illegal for doctors to prescribe them for pain treatment.

Pregnant women, nursing mothers or patients with documented hypersensitivity to naloxone can be prescribed the drug without the abuse control additive, but no others.

Shipley said he intends to file the bill in January at the start of the next legislative session, and he expects an easy passage into law.

“If you work out the dynamic costs, how much we pay for health care for people and to put them in jail for abusing these drugs, it’s actually less expensive to society to get them into the proper treatment programs,” the representative said.

Addiction specialist Kim Roller worked closely with Shipley to draft the legislation.

She said much of the fight will be to educate doctors and the public about addiction.

“People need to realize that it’s a disease,” she said. “A few years ago, there was a similar stigma attached to depression, but once people realized it was a true medical condition, that stigma has been mostly shed. That’s what we’re hoping for with Bella’s Law.”

After the meeting with the physicians, Roe said he intends to gather more information about addiction and the federal laws governing their treatment before taking action.

“It’s a sophisticated issue,” Roe said. “They educated me about the problem they’re facing, and I’m going to continue that education process.”

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