The AAFP told a federal agency that it generally supports efforts to increase the number of patients a physician can treat with medication for opioid addiction but pointed out problems in the agency's proposed rule that could stand in the way of success.
The proposed rule(www.gpo.gov) from the Substance Abuse and Mental Health Services Administration (SAMHSA) that was published March 30 in the Federal Register would increase from 100 to 200 the number of patients for whom a physician can provide medication-assisted treatment (MAT). In a May 26 letter(3 page PDF) to SAMHSA Acting Administrator Kana Enomoto, M.A., AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., outlined the reasons for the Academy's conditional support.
"The AAFP commends SAMHSA for this effort to increase the number of patients a waivered physician can treat with MAT, but this proposed rule is just an incremental step," Wergin wrote. "The proposed rule does not address the many reasons cited by our members as to why they are not prescribing MAT to the fullest extent of their current waiver."
Specifically, Wergin cited "concerns about governmental and third-party reimbursement for the additional reporting, documentation, counseling and other requirements to prescribe MAT, concerns about the on-site DEA inspections, as well as the challenges of access to the counseling services in many rural and underserved communities necessary to meet the requirements of MAT prescribing."
Physicians who already have waivers to treat 100 patients with MAT would qualify for the higher patient limit under the SAMHSA proposal. However, they would have to apply for another waiver in three years.
"The AAFP would suggest that rather than an arbitrary 3-year term, SAMHSA could propose that the highest patient limit should be based on a periodic review of that practice and its outcome statistics," Wergin wrote.
Reducing the opioid addiction rate is a top priority in Congress, where legislation that addresses prescription drug overdoses has strong support in the House and Senate. Among multiple measures under consideration are several proposals to increase the number of patients to whom a physician can offer MAT for opioid addiction.
Related AAFP News Coverage
Leader Voices Blog: Let's All Commit to Reverse the Opioid Epidemic
More From AAFP
Pain Management and Opioid Abuse