Magazine

Survey Results: Addiction Specialists Weigh In on the DATA 2000 Patient Limits

by ASAM Staff | December 7, 2015

In light of Secretary Burwell’s September announcement that the Department of Health and Human Services (HHS) will revise the federal regulations related to the DATA 2000 patient limits and in preparation to comment on the forthcoming proposed rule, ASAM surveyed addiction specialists to see how many are waivered to prescribe buprenorphine and how many are affected by the current patient limits. The survey was an update to one ASAM did in 2013, and the results indicate that patient demand for treatment has increased. 

  2013 2015 
 Responses  458  1,309
Waiver Status
 Waivered to treat up to 30 patients  17.3%  17.8%
 Waivered to treat up to 100 patients 71.9%  73.9% 
 Not waivered  10.8%  8.1%
 Patient Load (Percent of Waivered Physicians)
 Low: Fewer than 40 (2013) or 30 (2015) patients  44.2% 31.6% 
 Medium: Between 40 and 80 (2013) or 30 and 80 (2015) patients  17.0% 19.0% 
 High: More than 80 patients  37.1% 45.3% 
 Patient Demand for Treatment Exceeding the 100-Patient Limit (Percent of Waivered Physicians)
 Yes  41.5% 66.3% 
 No  55.0% 30.2% 

 

Compared to responses in 2013, more respondents in 2015 said:

  • They are waivered to prescribe to 100 patients
  • They treat more than 80 patients
  • They have patient demand for treatment in excess of the 100 patient limit

Thank you to those who responded to the survey! This information helps us better understand patient demand for buprenorphine treatment and how the current patient limits affect addiction specialists’ ability to offer it.

Please keep your eye out for an email from ASAM Advocacy when the proposed rule is released! We encourage all members to submit individual comments on the proposal, and will share ASAM’s official take on the proposed rule as soon as possible.

Questions? Contact ASAM Advocacy at advocacy@asam.org.

 survey infographic

Addiction Specialists - Waiver Status

Addiction Specialists - Patient Load

 Addiction Specialists - Demand for Treatment

17 comments

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  1. Dr. Padhiar MD Mar 11, 2016 - 11:17 AM
    I am seeing increasing number of suboxone pts in detox, some have been dissolving and injecting suboxone to get high, others want to get off suboxone, and are experiencing withdrawal, which they state is worse than heroin withdrawal, and lasts longer. There are cash only physicians, who dont properly monitor for counselling etc. Suboxone is available on the street, and is being diverted, and I am sure DEA has concerns regarding this, I hope these issues are addressed with CARA, or we will have another epidemic, suboxone abuse on our hands
  2. Daniel Bennett, MD Feb 02, 2016 - 03:08 PM
    I have read many opinions on the 100 patient limit. Some of them make sense, and some don't. Many, like the one offered by Dave Simon (see above) say that patient limits should not be increased for doctors who are not board certified in addiction medicine. Opinions like these sound absurd to me. What if the American Board of Medical Specialties were to say "Only board certified endocrinologists should be allowed to prescribe insulin to more than 100 patients"? What if ACOG said "Only board certified OB/GYNs should be allowed to deliver babies, or at least any others should be limited to delivering 12 babies per year"? I would like to remind you that almost any licensed physician can prescribe hydrocodone to 1,000 patients, or oxycodone to 2,000 patients. Should board certified Emergency Medicine physicians be the only ones allowed to work in hospital emergency departments? If so, there will be thousands of small hospitals across the country that will not have physician coverage of any type. Many people are concerned that lifting the 100 patient limit will cause the mass creation of "pill mills" but I would like to remind everyone that we already have "pill mills". They are called METHADONE CLINICS and many of them are run by physicians who are board certified in Addiction Medicine and who have the primary goal of making as much money as they can possibly make.
  3. Nancy Blake, M.D. Jan 21, 2016 - 01:48 PM
    I am not board certified in addiction medicine, I am a FP.  However, my practice is limited to treating addictions.  I can easily manage more than 100 patients.  I feel the limit should be increased for ANY physician treating patients, not just addiction specialists.
  4. Jo-Ann Bolli, M. D. Jan 13, 2016 - 01:26 PM
    In KY not only are we  limited to the 100 patients, we are not allowed to treat their psych co-morbidities like ADD, sleep disorders, or anxiety disorders.  If we are not Board Certified, we have a limit on dosing of 16 mg per day for one year, then we must find a Board Certified Addiction Medicine Specialist to consult. I live in a very small rural town, and draw from 4 states.  Our closest referral doctor is 5 hours away.
  5. John Budnick PA-C Jan 12, 2016 - 09:38 PM
    Allowing physician assistants who have a rich background in addiction medicine to assist in MAT with Suboxone would help immensely!!
  6. Jan Widerman D.O. Jan 12, 2016 - 09:20 AM
    The limit also impedes education in fellowship programs for addiction. What other specialty has limits on the number of patients you can treat? We all have to be able to make a living.
  7. Bob Rust, ABAM Jan 10, 2016 - 11:43 PM
    As an addiction specialist, it is difficult to get docs to accept my patients for family practice and seems impossible to get any of them to prescribe buprenorphine for pain for their patients who may be at risk for addiction. They are afraid to do so, even if the med is safer than opiates. Granted, off label, tho some forms are approved (patches). Fear is unfounded and due to insufficient education. Main fear is having addicts as patients. Need residencies to step up the education. Especially FM and IM.
  8. Dave Simon, M.D., J.D., DABAM Jan 10, 2016 - 09:31 PM

    An alternative to increasing the per physician limit is to recruit more physicians to get waived. Perhaps there should be other factors considered. For example, perhaps allow ABAM and AAAP board certified physicians an increased amount of patients above 100. I am concerned about the quality of practice of prescribing physicians. There are docs in the community well known to folks on the street that will provide prescriptions with minimal accountability, monitoring or treatment.

    Also, the limit should be tied into matching economic needs. For example, the demand in my area far greatly exceeds the supply of prescribing physicians WHO ACCEPT MEDICAID. If we want to match supply with demand, then count Medicaid patients as 0.5 and others as 1.0, so a physician can prescribe, e.g., for 100 Medicaid patients (100 x 0.5 = 50) and 50 other patients, or 150 total patients of whom 2/3 are Medicaid. Future policy should be directed to meeting needs of patients more so than merely allowing some physicians to treat more 'high end' private insurance and self-pay patients while leaving other physicians to serve the indigent and Medicaid populations.  

    I DO believe reasonable limits SHOULD be in place to guard against 'Suboxone mills' and to promote high quality care, and to incentivize physicians to provide treatment across a wide socioeconomic spectrum.

  9. Molly Rossignol, DO FAAFP Jan 10, 2016 - 07:46 PM

    I just sat down to try to figure out how many patients I can 'accept' from other practices - since I am one of the only docs in town with an x waiver. This includes patients from OB practices where it seems commonplace and 'natural' for the young women to buy subutex on the street - i get calls nearly daily from the docs or the OB floor - then there is the practice I was hired to cover MAT for - I just calculated that I can offer to treat 11 patients from there (because they only cover 1/9th of my salary). This is heresy. Not a topic I should have to go take administrators' time about and especially not have to turn people away about - I admit I worry about pill mill evil...rewatch ASAM forum from Austin - very good discussion. 

  10. Don Taylor Jan 06, 2016 - 02:11 PM
    The 100 patient limit kills people. Is our government so callous that they would execute hundreds of citizens by denying them access to buprenorphine by limiting how many patients a physician can see? I can prescribe oxycodone to a 1000 patients but I can only treat 100 with buprenorphine for addiction. Is this not madness?
  11. John Ewing MD Jan 05, 2016 - 10:58 PM

    I have had the unfortunate experience of talking to parents whose children I had to turn away for treatment due to the 100 patient limit.  The unbearable sadness in their eyes as they wait for that dreaded phone call is truly heart wrenching.

    My most dreaded encounters are from the ER when I have had to tell the parents that their child is dead.

    I am glad for what we have.  I would like to be able to treat more patients.

    The vast majority of Physicians are good people trying their best to help without bringing harm.

    I watched the eyes of a senior resident at our team meeting today and her sadness at our triage process which consists of turning away patients.

  12. John J Schermerhorn MD FASAM DABAM Jan 05, 2016 - 06:15 PM
    I feel that the limit needs to be increased as soon as possible. For those of us that do this every day, it is imperative to be able to treat more than 100 pts. I would add one caveat to the increase, however. It should be limited to those physicians who accept Medicare and Medicaid so that that the "pill mills" can't profit from the increase. It might make more physicians  morally responsible treating this disease. 
  13. Brent Boyett Jan 05, 2016 - 02:49 PM

    Buprenorphine is either a legitimate treatment for a legitimate disease or it is not.  The 100 limit is unprecedented in other disease states and it contributes to the counterproductive stigma of addiction. 

    Imagine an endocrinologist that is only allowed to treat 100 patients at a time or a cardiologist turning away CHF patients because he/she has reached their federally mandated limit. 

    We say that it is a chronic disease, but we do not treat it that way.

     
  14. Kurt Haspert, CRNP Jan 04, 2016 - 07:44 PM
    Why not let qualified CRNP's prescribe Suboxone?
  15. R. W. Reed, M.D Dec 25, 2015 - 09:33 PM
    Please allow all patients who need treatment to get treatment. This is an illness like every other illness that needs the care of a physician, more because waiting can kill these precious patients. A 250-patient limit is a safe start. There are not enough waived physicians to give this much needed care. A waiting list is tragedy waiting to happen. I hear and see the anguish in the voices and faces of mothers looking for physicians to treat their children addicted to opiates, particularly heroin. They should get help they need it and not when it becomes available.
  16. Judith Dischel, MD Dec 22, 2015 - 07:02 AM

    Who are we to decide who gets treatment and

    who doesnt?  It's a deadly disease and I don't like

    playing God.  No other disease has limits like this.

  17. Chuck Russell, MD, DABAM Dec 15, 2015 - 10:14 AM
    Increasing Bupe MAT can't happen soon enough....folks who couldn't get into treatment when they were ready for it are dying every day. With this disease, a waiting list is a tragedy.....IJS

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