[Congressional Record Volume 150, Number 78 (Monday, June 7, 2004)]
[Senate]
[Pages S6490-S6491]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
AMENDING THE CONTROLLED SUBSTANCES ACT TO LIFT THE PATIENT LIMITATION
ON PRESCRIBING DRUG ADDICTION TREATMENTS BY MEDICAL PRACTITIONERS IN
GROUP PRACTICES
Mr. COCHRAN. I ask unanimous consent the Senate proceed to the
immediate consideration of Calendar No. 542, S. 1887.
The PRESIDING OFFICER. The clerk will report the bill by title.
The legislative clerk read as follows:
A bill (S. 1887) to amend the Controlled Substances Act to
lift the patient limitation on prescribing drug addiction
treatments by medical practitioners in group practices and to
amend the Controlled Substances Act, and so forth, and for
other purposes.
There being no objection, the Senate proceeded to consider the bill.
Mr. COCHRAN. Mr. President, I ask unanimous consent the bill be read
a third time and passed, the motion to reconsider be laid upon the
table, and any statements be printed in the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
The bill (S. 1887) was read the third time and passed, as follows:
S. 1887
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. ELIMINATION OF THE 30-PATIENT LIMIT FOR GROUP
PRACTICES.
Section 303(g)(2)(B) of the Controlled Substance Act (21
U.S.C. 823(g)(2)(B)) is amended by striking clause (iv).
Mr. LEVIN. Mr. President, this legislation, S. 1887, ensures that all
appropriately trained group practice physicians may prescribe and
dispense certain recently approved drugs for the treatment of heroin
addiction. It addresses the unintended effect of the Drug Abuse and
Treatment Act of 2000, DATA, that hinders access to new treatments for
thousands of individuals who seek such help.
When Congress passed DATA as Title XXXV of the Children's Health Act
of 2000, Public Law 106-310, it allowed for the dispensing and
prescribing of Schedule III drugs, like buprenorphine/naloxone, in an
office-based setting, for the treatment of heroin addiction. As a
result of DATA, access to drug addiction treatment is significantly
expanded; patients no longer are restricted to receiving treatment in a
large clinic setting, but now may receive such care from specifically
trained physicians in an office-based setting.
DATA limits qualified individual physicians to treating no more than
30 patients at a time. The interpretation of the law results in the
same 30-patient limit on physician groups. For example, the physician
members of the Duke University Medical School faculty practice plan may
treat only 30 patients at one time, even though they may have ten
individual physicians trained and willing to treat patients and more
than 30 patients would benefit from newly available treatment. The
difficulties that have arisen, including the dashed hopes for treatment
of many, due to the patient limitation on group practices, are detailed
in a May 30 article in the Boston Globe, by Peter DeMarco. I would like
to share a few excerpts from that article with my Colleagues, as
follows:
When buprenorphine became available as a treatment for
OxyContin and heroin addiction 18 months ago, many medical
professionals and addicts hailed it as a miracle drug,
bringing addicts back from the brink and helping them lead
normal lives when all else had failed. But for many addicts,
buprenorphine remains one of the hardest drugs to obtain.
Approved by the Federal Food and Drug Administration in 2002,
buprenorphine is an opiate like heroin or the painkiller
OxyContin. Unlike those drugs or methadone, the prescribed
drug it's meant to replace, buprenorphine doesn't cloud the
minds of patients, allowing them to work or study as if
they're not on any drug at all. Nearly all who take
buprenorphine, meanwhile, say they lose all physical cravings
for street drugs.
But a combination of federal limits on the distribution of
buprenorphine, and reluctance on the part of some physicians
to offer it to patients has kept thousands of opiate addicts
from receiving the drug in Massachusetts and across the
country. At the heart of the issue is federal legislation
passed in 2000--two years before the drug was approved by the
FDA--that restricts individual clinical practices from
treating more than 30 patients with buprenorphine at a time.
While many substance-abuse experts say the 30-patient
figure is too low for some practices, their main quarrel with
the Drug Addiction Treatment Act of 2000 is its failure to
differentiate single-physician practices, hospitals, and
health care organizations. For example, all the doctors who
work for Tufts Health Plan can treat a combined 30 patients--
the same total as can be seen by a physician practicing
alone.
Boston health officials, along with their counterparts in
the State and Federal governments, say the Federal
legislation erred on the side of caution, and needs to be
changed to allow wider access to buprenorphine.
``Boston Medical Center's main practice has 200 or more
general internal-medicine doctors, and within that practice,
we can only treat 30 people. It's the craziest loophole,''
said Colleen Labelle, nurse-manager of the hospital's Office-
Based Opioid Treatment Program. ``We get 20 calls a day from
across the state. People are begging, desperate to get
treated, who we can't treat.''
The Federal Substance Abuse and Mental Health Services
Administration has begun an internal process to increase the
30-patient cap. But because any proposed change would be
subject to the public-review process, approval could take as
long as two years, said Nick Reuter, a senior public health
analyst with the agency.
It clearly was not the intention of DATA that individuals seeking
treatment have less access to new medications simply because they
receive care from a physician practicing in a group, or from a group-
based or mixed-model health plan. Nevertheless, this is the is the
effect and it is having a severe effect. The problem is addressed by
removing the 30-patient aggregate limit on medical groups. The patient
limitation would remain on individual treating physicians. This is
achieved in the bill, S. 1887, which I introduced along with Senators
Hatch and Biden. It simply removes the statutory limit on the number of
patients for whom doctors in medical groups may prescribe certain newly
available, FDA-approved medications to treat heroin addiction.
I would like to close with another excerpt from Mr. DeMarco's article
regarding the positive impact buprenorphine treatment has had on an
individual who was fortunate enough to seek and help and not be turned
away. It is as follows:
Timothy Tigges says his addiction began after he wrenched
his back and bummed a few Percocet pills, a prescription
analgesic, from a friend to dull the pain. Before he knew it,
he was hooked on opiates, alternating between OxyContin and
shooting up heroin as his life went to pieces.
In October, Tigges, a 27-year-old East Boston carpet
installer, began taking buprenorphine, placing an orange pill
the size of a dime under his tongue until it dissolves, four
times daily. He hasn't touched an illegal drug since the day
he started the program, has put on 80 pounds from lifting
weights at the gym, and has yet to miss a day of work. For
the first time in three years, Tigges hopes to see his 5-
year-old daughter, whose mother has refused to let him visit.
[[Page S6491]]
``I've had clean urines, 100 percent, for nine months now.
There's nothing I'm prouder of than that,'' he said, choking
back emotion. ``What I read on the front page of the paper
every day is 18- and 20-year-old kids dying of garbage drugs.
There's just no need for it. I would take every ounce of
heroin off the street and give them this stuff. You watch the
crime rate go down.''
Mr. COCHRAN. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. CORNYN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. CORNYN. Mr. President, I ask unanimous consent I be allowed to
speak for 20 minutes in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.
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