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Rise in opiate addiction spurs call for more treatment options

The number of pregnant women seeking treatment for their addictions to opiates and other drugs has more than quadrupled in recent years at one of the region’s biggest providers of drug treatment and mental health services.

Three years ago, 29 expectant mothers sought treatment at Horizon Health Services.

Last year, that number increased to 126, and if the demand for help continues at its current pace, Horizon officials estimate 132 pregnant mothers will seek drug treatment by the end of this year.

The rise in the number of women seeking help comes at a time when Western New York hospitals are seeing more babies born addicted to opiates. The state Health Department has determined that as many as 554 babies were born with such addictions between 2010 and 2012 in Erie County alone, translating into a rate of 189 newborns testing positive for drugs out of every 10,000 births.

But the problem extends far beyond Western New York.

The number of babies born with “neonatal abstinence syndrome” nationally has increased by about 300 percent between 2000 and 2009, according to recent testimony in Washington to the House Subcommittee on Oversight and Investigations. The panel is looking into the causes of the epidemic that has claimed hundreds of lives locally and thousands nationally.

Compounding the problem, according to local drug treatment specialists, is the long waiting list for addicts who want to see physicians federally certified to prescribe buprenorphine – also known as Suboxone – as a form of treatment. The drug helps wean addicts from abusing prescription painkillers and heroin.

Efforts to expand access to certified physicians and allow nurse practitioners and physician assistants to prescribe buprenorphine to treat addiction took a step forward in recent weeks in Washington, D.C.

Rep. Brian Higgins, D-Buffalo, and U.S. Sen. Edward J. Markey, D-Mass., announced the introduction of companion bills that would allow certified doctors to see more addicts seeking buprenorphine and also give the nurse practitioners and physician assistants the authority to write buprenorphine prescriptions for addiction treatment. At present, the latter two can only prescribe the drug to treat pain.

“When effective medication-assisted treatment is made available, people’s lives can be saved,” said Markey, who introduced the bill in the Senate with Sen. Rand Paul, R-Ky. “Treatment for prescription drug and heroin addiction should not be harder to access than the actual drugs destroying lives and communities.

“The TREAT Act will expand access to medical treatment that works, removing outdated limits on trained health professionals, allowing them to treat more patients and address this opiates crisis.”

Such legislation, local officials say, is overdue. For area pregnant women, the wait to see a certified doctor can be two weeks; other addicts wait up to a month for a buprenorphine prescription.

In Erie County, there are 126 certified physicians and in Niagara County, 10, according to the U.S. Drug Enforcement Administration. Nationally, there are 29,194 certified doctors. Certification requires physicians to pass an eight-hour online course.

Some of the area’s certified doctors refuse Medicaid as payment, because of the low reimbursement rate, while others require cash payments for treatment. Those restrictions reduce the accessible pool of doctors who treat opiate-dependent individuals, treatment experts say.

In addition, federal regulations prohibit physicians from having a caseload of more than 100 patients being treated at the same time with buprenorphine; and in the first year of this type of practice, physicians can have only 30 patients.

“I always compare this to diabetes. Could you imagine being a newly diagnosed diabetic knowing that you need insulin, but you can’t get it because there is not a qualified physician available? You’re going to have to go on the wait list. Do what you can to manage yourself in the next few weeks and we’ll call you as soon as we can,” said Paige Prentice, Horizon’s vice president of operations.

To reduce the delay for pregnant women seeking treatment, they are put at the top of the waiting list, she said.

“I would say the wait could be days to a couple weeks for pregnant women. It is a supply and demand issue and right now the demand is way, way higher than the supply,” Prentice said. “We have five doctors we work with.”

In making a case for approval of the legislation, Higgins said more than 60 people die every day in the United States from prescription drug overdoses and that more tools are needed to fight the epidemic.

“Addiction experts agree that individuals suffering from an opioid addiction need access to a broad range of treatments, including medication-assisted therapy,” Higgins said. “Treatments limited to rapid detoxification or forced abstinence have proven to be inefficient and frequently lead to overdoses during the first month of abstinence.”

In addition, more and better-trained health care professionals are needed to deal with the opiate epidemic, according to North Buffalo resident Avi Israel, whose 20-year-old son, Michael, killed himself after becoming addicted to prescription painkillers while being treated for Crohn’s disease. The health system, Israel said, is currently overwhelmed with doctors who prescribe highly addictive prescription opiate painkillers, but too few who are federally certified to treat patients if they become addicted.

“What happens is the doctors get them addicted and then they say they can’t treat them. They can’t prescribe for them any more because they don’t have the federal qualification to treat addiction,” Israel said. “We have every Tom, Dick and Harry prescribing prescription narcotics and then there is Joe prescribing Suboxone and he can’t keep up with the other three doctors.”

Israel has also been pushing for a state law requiring training of doctors in how to spot addiction and treat addicts.

Erie County Health Commissioner Gale R. Burstein, in supporting the federal legislation, said greater access to buprenorphine would reduce the number of “bad outcomes” addicts often experience in illegally using opiates. Last year, 119 individuals died from opiate overdoses in Erie County and this year, the number could nearly double if the present rate of overdoses continues.

Responding to the concern that doctors too readily write prescriptions for opiate pain medications, Burstein said they should only prescribe opiates if no other medication works.

“There are many different types of pain medications starting with nonsteroidal anti-inflammatory drugs like ibuprofen. There’s also acetaminophen and hopefully health care providers would start with the medication that has the lowest side-effect profile instead of the big guns, prescription narcotics, for pregnant women and anybody else because the prescription narcotics are very addictive,” Burstein said.