March 25, 2015
Tennessee General Assembly
House Subcommittee on Health
301 6th Avenue North
Nashville, TN 37243
Dear Committee:
The Center for Lawful Access and Abuse Deterrence (CLAAD) is concerned about House Bill 929
(HB 929) and the implications it has on access to care for individuals with substance use disorders seeking
addiction treatment. CLAAD is a national, not-for-profit organization working to reduce prescription drug
abuse while protecting patient access to care. Since 2009, CLAAD’s National Prescription Drug Abuse
Prevention Strategy has called for the expansion of interventions and referrals to treatment for individuals
with substance use disorders.1 The National Strategy has earned the endorsements of over 30 not-for-profit
organizations, including the Drug Free America Foundation, National Family Partnership, the American
Chronic Pain Association, Community Anti-Drug Coalitions of America, and NAADAC – The Association
for Addiction Professionals.
As the nation addresses what the Centers for Disease Control and Prevention has identified as a
prescription drug abuse epidemic with more than 16,000 opioid-related overdose deaths each year,
medication-assisted therapy (MAT) provides individuals with substance use disorders the opportunity to focus
on their psychosocial recovery efforts and lead healthy, productive lives.
In their current form, HB 929 and Senate Bill 829 (SB 829) require nonresidential treatment centers
providing MAT to more than 150 patients, including those on the premises of a physician’s office, to obtain a
certificate of need (CON) by July 1, 2016. While CON requirements already apply to methadone providers,
these bills would expand CON requirements to buprenorphine treatment providers. Unlike methadone, a
Schedule II controlled substance, buprenorphine is a long-acting partial opioid agonist that is classified as
Schedule III and thereby poses a lower degree of risk.2
These bills have the potential to eliminate access to care for Tennesseans living in areas where
physicians at community-based, CON-approved facilities have met federal prescribing limits, or where
facilities exist that do not possess a CON and, therefore, MAT is restricted. In fact, if physicians are required
but unable to obtain CONs in order to practice MAT, their patients may be left without a treatment provider
and are more likely to relapse to substance use or seek diverted buprenorphine from pill mills or other illicit
sources in order to self-medicate.
1
http://claad.org/wp-content/uploads/2013/10/Nat_Prescipt_Drug_Abuse_Prev_Strat_2009.pdf
Mori J. Krantz, MD; Philip S. Mehler, MD, "Treating Opioid Dependence: Growing Implications for Primary Care," Archives of
Internal Medicine, (Chicago, IL: American Medical Association, February 2004), Vol. 164, p. 281.
http://archinte.jamanetwork.com/article.aspx?articleid=216641.
2
Center for Lawful Access and Abuse Deterrence
1000 Potomac Street NW, Suite 150-A • Washington, D.C. 20007 • (202) 599-8435 • www.claad.org • @CLAAD_Coalition
In 2013, 22.7 million persons aged 12 or older needed treatment for an illicit drug or alcohol use
problem, and yet, 89 percent went untreated.3 There is currently a shortage of physicians licensed to practice
MAT, and due to federal patient limits imposed on practitioners under the Drug Addiction Treatment Act of
2000, those who are licensed to practice MAT often have long waitlists of patients that they are unable to
treat. By adding yet another restriction on the practice of MAT, HB 929 and SB 829 place further barriers in
the path of individuals at high risk of suffering overdose-related death without proper treatment.
More effective ways exist to address concerns around buprenorphine diversion and the proliferation of
pill mills. We would be pleased to work with you to advance prescriber education requirements, mandatory
prescribing standards, professional sanctions and rehabilitation, and referrals to law enforcement when public
health authorities identify criminal activity.
According to the Substance Abuse and Mental Health Services Administration (SAMSHA), 475
physicians and 24 opioid treatment programs are currently providing opioid-substitution therapy in
Tennessee.4 With limits already in place on physicians prescribing buprenorphine for addiction treatment,5 a
CON could further restrict access. Further restricting access to care could lead to the prescribing of higher
dosages and diversion to others seeking buprenorphine, resulting in misuse and abuse. As we have already
seen with the prescription drug abuse epidemic, restricting access to treatment can result in unintended
consequences on public health and safety, including emergency department visits, the spread of infectious
diseases, increased costs to taxpayers for publicly-funded health care, lost productivity, increased crime, and
overdose-related deaths.
Buprenorphine permits individuals with substance use disorders to function normally within their
families, jobs, and communities.6 As policy makers, law enforcement, health care practitioners, and
stakeholders, including CLAAD, continue to address prescription drug abuse, it is critical that we avoid
enacting policies that restrict access to addiction treatment.
Thank you for the opportunity to voice our concerns about HB 929 and SB 829. If you have any
questions, please contact us at (202) 599-8435 or [email protected].
Sincerely,
Kyle Simon
Director of Policy and Advocacy
3
Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, Substance Abuse & Mental
Health Servs. Admin. (2014),
http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf.
4
http://buprenorphine.samhsa.gov/pls/bwns_locator/
5
https://www.naabt.org/30_patient_limit.cfm
6
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (April 23, 2013).
The N-SSATS Report: Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011.
Rockville, MD, p. 2. http://archive.samhsa.gov/data/2k13/NSSATS107/sr107-NSSATS-BuprenorphineTrends.pdf
2