WASHINGTON -- The head of a nonprofit organization that represents drug courts lobbied the U.S. Department of Health and Human Services against increasing access to a key addiction treatment.
In an Aug. 19, 2014, letter obtained by The Huffington Post through an open records request, West Huddleston, the then-CEO of the National Association of Drug Court Professionals, wrote HHS Secretary Sylvia Mathews Burwell and urged her to keep strict caps on the number of opioid addicts doctors can treat with buprenorphine. Use of the medication along with counseling, known as medication-assisted treatment, is considered by public health officials to give opioid addicts the best chance at a recovery. But many drug court judges have opposed the treatment, insisting defendants go cold turkey instead.
In the U.S., doctors must be certified to prescribe buprenorphine (sold under the brand name Suboxone) and then are allowed to prescribe it to only 30 patients at any one time during their first year. Doctors are limited to 100 patients for subsequent years. The epidemic has led certified doctors to start keeping waiting lists of addicts seeking buprenorphine prescriptions. In more rural communities, as HuffPost recently reported, recovering addicts have to drive hundreds of miles to find a doctor who can write them a prescription.
But Huddleston didn’t think the epidemic was reason enough to change the policy -- one that he thought safeguarded against unscrupulous doctors. “I am writing with continued grave concern regarding potential changes to the HHS/SAMHSA buprenorphine guidance that would lift the 100-patient limit for physicians prescribing buprenorphine,” Huddleston wrote. He concluded that the NADCP “is strongly opposed” to changes “that will result in the expanded use of buprenorphine in a manner that is less responsible and presents greater risk to the health and safety of the individuals and communities we both serve.”
The same year Huddleston wrote his letter to Burwell, more than 28,000 Americans died from opioid overdoses, according to a recent Centers for Disease Control and Prevention study. It’s unclear what influence, if any, his lobbying had on HHS. Burwell replied, thanking him for his concern. He may have gotten a worse response from the Substance Abuse and Mental Health Services Administration (SAMHSA). In his letter, Huddleston references writing a similar missive to a top official at that agency and being “disheartened by the response.”
Huddleston's lobbying efforts were not successful. This past September, Burwell announced that HHS will be reforming the patient limits in an effort to expand access. Drafts of the new regulations are still being worked on, according to an HHS spokesperson.
But Huddleston’s opposition at least highlighted a significant conflict between public health officials and drug court personnel. Last February, following a HuffPost investigation, the White House’s Office of National Drug Control Policy announced that any drug court receiving federal funds could not bar defendants from taking medication-assisted treatment.
Dr. Stuart Gitlow, the immediate past president of the American Society of Addiction Medicine, thinks Huddleston had no business lobbying over health care policy. “For godsakes just let doctors do their job and let us give the appropriate medication and treatment as we do for any other disease,” he said. “Why is a legal system that has no medical skill set, knowledge, capabilities getting involved with something they know nothing about? What would we say if the state Senate said to doctors: You shouldn’t be allowed to prescribe medications to more than 50 hypertensives per month?”
Huddleston has left the drug-court nonprofit, but said in an interview this week that he still stands by his letter. He called lifting the caps “a short-term Band-Aid for a very serious problem."
Huddleston’s former employer now says it approves of lifting the patient caps.
“The letter you’re referencing no longer reflects our current position on the issue,” said Christopher Deutsch, NADCP's director of communications. “Right now, we’re looking forward to seeing the results of the administration’s review. Obviously, nobody should be denied access to an evidence-based medication when appropriate. Our focus is making sure the drug-court community is educated on the use of MAT and on adopting best practices.”
UPDATE: Feb. 18, 10:52 a.m. -- Deutsch later clarified to HuffPost that while the letter doesn't reflect the group's current position, the group has not settled on a new position. "We do not currently have a position against lifting the caps and, as the quote says, the letter does not reflect our current position. In lieu of an official position we are waiting to see what the administration recommends following a review of the research and consultation with the medical community and other relevant experts," said Deutsch.
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