TnSAM President Discusses Addiction Issues With Senator Bob Corker’s Staff

Dr. John Standridge had the opportunity June 21, 2013, to speak with Senator Bob Corker’s staff via a conference call. Among the participants was Jenifer Healy, Senator Corker’s DC staff member for medical issues. The following are the topics discussed, with a focus on neonatal abstinence syndrome babies. This outline of bulleted topics and talking points was also emailed to Senator Corker’s staff as a review and to facilitate presenting the topics to the senator. We hope to have far more encounters with key legislators in the future as TnSAM gains recognition as the voice for addiction medicine in Tennessee.

Neonatal Abstinence Syndrome (NAS) is a growing and very expensive burden to society and governmental resources.

—  There has been 10-fold increase in neonatal abstinence syndrome babies born in Tennessee from 2000 to 2010 according to the state hospital discharge database.

—  Beyond the pain and suffering a newborn experiences, NAS also has a tremendous economic impact.

—  According to TennCare, a baby with NAS cost 5.6 times more than a baby without NAS in 2010.

—  TennCare infants with NAS are 18 times more likely to enter state custody than infants without NAS.

—  There are not enough physicians with the DEA waiver to prescribe buprenorphine to serve the opioid-dependent population for which the medicine was intended.

—  Essentially all of these physicians with the DEA waiver have reached their 100-patient limit and can accept no more patients.

—  Most of these physicians with the DEA waiver have a waiting list of potential patients who seek treatment, and no option for accommodating a pregnant opioid-dependent woman.

—  Opioid-dependent women who become pregnant have no access to care and have limited options.

—  Withdrawal from opiates can induce miscarriages.

Buprenorphine treatment in pregnancy: less distress to babies

—  NIH study compares buprenorphine to methadone in opioid addicted pregnant women

—  Compared to methadone, buprenorphine resulted in similar maternal and fetal outcomes, yet had lower severity of NAS symptoms, thus requiring less medication (1.1 versus 10.4 milligrams) and less time in the hospital for their babies (10 versus 17.5 days).

—  The Maternal Opioid Treatment: Human Experimental Research (MOTHER), published in the New England Journal of Medicine, was one of the first to prospectively follow opioid-dependent pregnant women from enrollment until at least 28 days after giving birth. The eight-site international study included 131 mothers and their newborns.

—  Dr. Hendree Jones, the primary study author said, “We were pleased to be able to identify a medication that lessens the withdrawal distress to newborns, and gets them out of the hospital more quickly.”

SOLUTION:      Defense of the Unborn Child Amendment to DATA 2000.

—  Pregnant opioid dependent women will not count against a qualified physician’s 100 patient limit as defined in DATA 2000.

—  This waiver against a qualified physician’s 100 patient limit would extend for 2 years postpartum in order to promote stability of early child care.

—  As further incentive to enter treatment, a woman entering treatment would gain advocacy so as to not lose custody of her child for opiate dependency alone.

Addiction is America’s number one health problem (RWJ Foundation) and treatment is essentially neglected. CASA Columbia’s new five year national study, released June 26, 2012, reveals that addiction treatment is largely disconnected from mainstream medical practice.

—  Non-medical use of prescription pain relievers is 22M nationally, or 4.6%; 5% in Tennessee.

—  The treatment gap is 95.3%

—  19.3M people need treatment for opiate dependency but are not receiving it



Proper treatment is highly effective, with abstinence rates maintained at nearly 80% over 5 years.

—  78 percent of doctors in treatment programs had no positive drug tests during five years of intensive monitoring.

—  More than three-quarters of doctors enrolled in state programs stayed drug-free over a five-year monitoring period. The results were the same regardless of whether the doctor’s drug of choice was alcohol, crack cocaine, prescription drugs or other substances.

—  “It should be a model for treatment of anyone with these diagnoses.”

—  In general, rates of prescription misuse are five times higher among physicians, according to a 2008 review in the Harvard Review of Psychiatry.

—  Society would and should be OUTRAGED if physicians, relative to the general population, had such a disproportionate outcome for heart disease as it does for addiction treatment.

Opioid dependence:

—  Is a growing national health crisis that affects people from all walks of life.

—  Creates a large burden on society, with increasing emergency department visits and fatalities

—  Is a chronic, relapsing brain disease that is manageable but requires long-term treatment to avoid relapses

—  Can be treated effectively in a primary care setting

—  Benefits of treatment outweigh costs of no treatment

—  Treatment is good clinical practice and can be personally rewarding to physicians

—  The Drug Abuse Treatment Act of 2000 (DATA 2000) permits qualified physicians to obtain a waiver to treat opioid dependence in their offices

—  Death rate from prescription drug overdose now exceeds motor vehicular accidents.

Parity – equality in access, benefits, coverage, respect, and treatment – would improve access to care.

Please support expeditious issuance of a final rule on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), to provide much needed certainty and access to vital mental health and substance abuse services.