Briefly Noted

Abstract

In an oft‐repeated myth, perpetuated by STAT this week in an article about a move to eliminate the waiver requirement for buprenorphine prescribing, the American Association for the Treatment of Opioid Dependence (AATOD) is frequently assumed to have tried to oppose DATA 2000, the law that enabled buprenorphine to be prescribed to treat opioid use disorder. This was the first real competitor to opioid treatment programs (OTPs), which constitute the membership of AATOD. We asked AATOD to respond, because STAT simply stated it as a fact, and because we covered much of the regulation process and did not observe this to be a fact at all. “And in the early 2000s, when buprenorphine was first approved, some treatment advocates, including AATOD and other methadone providers, lobbied to keep buprenorphine tightly restricted. Initially, physicians waivered to prescribe the drug could only treat 30 patients — a cap later relaxed to 100, then 275,” according to STAT. However, it was the federal government that was concerned about diversion and pill mills — specifically, the Substance Abuse and Mental Health Services Administration (SAMHSA). “We did not oppose DATA 2000,” AATOD President Mark Parrino told us last week. “This was a popular myth at the time and continues to this day.” Parrino continued: “When DATA 2000 was being marked up, we had two specific questions. The first question was about eight hours being enough training for medical practitioners, who had no previous experience, in treating opioid use disorder. There was no answer to that aside from not inconveniencing physicians with any more training. The second question was concerning the language ‘capacity to refer’ the patients to counseling. Our argument was that this language was meaningless, since there was no guidance on how the practitioner would follow through on this.” As far as AATOD can tell (and us too), very little counseling is either made available on‐site or through a referral. SAMHSA doesn't require any recordkeeping on this, so nobody knows. “The other part of the myth of AATOD's position is that we were protecting the interests of OTPs as the only providers of opioid disorder treatment,” said Parrino. “This is also not true, and no evidence exists to have supported this issue.” For the otherwise excellent STAT story, go to https://www.statnews.com/2019/04/30/loosen‐restrictions‐on‐prescribing‐buprenorphine‐addiction‐treatment/.