Philadelphia enlists doctors to expand opioid addiction treatment

HE1TREATMENT21
Buprenorphine tablets

With treatment for opioid addiction in distressingly short supply even as need increases year after year, Philadelphia’s behavioral health agency invited physicians and other medical providers to a half-day teach-in Tuesday titled the Buprenorphine Summit.

The topic turned out to be enticing enough – and the problem big enough – that more than 200 health professionals showed up. 

Buprenorphine is one of three types of medication that are known to significantly improve the odds of successful treatment for opioid addiction, and many experts say it is vastly underused. Families often report that doctors who are approved to prescribe it insist on hundreds of dollars in cash and may not make it part of a comprehensive treatment program, including intensive counseling, that is necessary for it to make a lasting difference.

In Philadelphia, there are plenty of treatment slots for methadone maintenance – another treatment medication backed by evidence – “but the availability of buprenorphine through insurance has been limited for people. Our goal is to see that access expand dramatically as another treatment option,” said summit organizer Rose Julius, a deputy chief medical officer for Community Behavioral Health. CBH handles all behavioral health coverage for Medicaid in the city.

Julius said a future summit would cover the third type of medication for opioid addiction, also considered underused, extended-release naltrexone.

Deaths from overdoses of opioids – both prescription painkillers and heroin – have skyrocketed across the country in recent years, and Pennsylvania’s fatality rate in 2014, the most recent available nationally, was far higher than average and trending higher. (New Jersey’s was below average.)

Gov. Wolf has called for a joint session of the legislature to address what he has called “a crisis” of opioid and heroin addiction in the state.

On Tuesday, the Democratic governor joined dozens of elected officials, advocates and others to rally in Harrisburg for tougher laws to combat the problem. He told a crowd of several hundred people that the state has already taken steps to curb abuse and addiction, including providing a database for doctors to check drug histories and identify patients who may be seeking to attain painkillers through multiple doctors.

“This is not about politics, this is about the people of Pennsylvania,” he said.

Wolf is pushing for the legislature to pass a number of bills before its two-year session ends in November, including requiring doctors to check the new database every time they prescribe painkillers and limit to seven days, with some exceptions, the amount of time emergency room doctors can prescribe opioids.

At the Buprenorphine Summit in Philadelphia, meanwhile, presenters discussed complexities that may have prevented some physicians from offering the medication. Unlike methadone, which is rigidly regulated and typically must be dispensed daily at designated clinics, buprenorphine may be prescribed at a physician’s office, for longer periods of time.

But it requires special training (which, attendees learned, may be available free) and a federal waiver that limits the number of patients that each physician is allowed to treat. (The Obama administration recently increased that number in an effort to expand access to treatment.)

Buprenorphine, which is commonly known by one of its brand names, Suboxone, is not a cure; it works by eliminating withdrawal symptoms so the patient, in counseling, can focus on the behavioral training necessary for long-term recovery. Tuesday, presenters discussed the different ways they have incorporated the medication in their treatment programs: some inpatient, others outpatient, with various combinations of groups and frequency of meetings. But all stressed that it could not be expected to work by itself.

They also emphasized the importance of verification – urine testing under observation and counting how many pills the patient had left, among other strategies – to ensure that the buprenorphine was not being diverted and perhaps sold on the street.

The medication prevents withdrawal symptoms because it is a form of opioid. Although it doesn’t have the intensity of heroin, addicts may buy it to temporarily avoid withdrawal symptoms or, in some cases, in an effort to treat their own addiction because they couldn’t find or get into a qualified program.

Julius, the organizer, said in an interview after the summit that her city agency covers treatment with buprenorphine at 12 outpatient locations. Her goal, she said, would be to have that “at least double by this time next year.”

Staff writer Angela Couloumbis contributed to this article.