Heroin treatment requires legal reform

Pharmacists, nurse practitioners and others can help in the battle against heroin — if given a chance

Opioid overdose and dependence are enormous public health problems in the U.S. As The Sun reported this week, Gov. Larry Hogan has rolled out a strategy to fight heroin ("Hogan unveils plan to fight heroin," Feb. 24). A Baltimore task force is considering the city's heroin-related treatment needs. And City Health Commissioner Dr. Leana Wen has written recently in The Sun that naloxone is the key to preventing overdose deaths. Studies show that medications like Suboxone, a combination of buprenorphine and naloxone, can reduce opioid overdoses, drug use, disease transmission and criminal activity while increasing the number of patients who remain in treatment. Still, there continues to be a limited number of physicians offering buprenorphine treatment. We believe pharmacists could play a key role in providing patients access to life-saving treatment.

Federal law allows certain physicians to prescribe Suboxone to treat opioid dependence in an office-based setting. However, other potential prescribers such as pharmacists, physician assistants and nurse practitioners cannot prescribe this medication, further limiting patient access. Collaboration within the health care team could ameliorate some the demands that Suboxone treatment can place on a physician, including intensive monitoring of patients and the stigma associated with treating patients with substance use disorders. Collaborative drug therapy management (CDTM), in which specially trained pharmacists order medications in partnership with physicians, could be particularly effective in increasing access to buprenorphine.

Maryland law already allows physicians and pharmacists to manage patients together using collaborative drug therapy management agreements, but current federal law does not permit non-physicians to prescribe buprenorphine. As board-certified, psychiatric pharmacists involved in the treatment of patients with substance use disorders, we believe that a critical way to improve access to Suboxone would be to change this federal law. Congress should act to allow specially trained pharmacists to prescribe buprenorphine. Doing so could expand access to this life-saving and life-changing medication.

Bethany DiPaula and Raymond C. Love, Baltimore

The writers are, respectively, associate professor and professor of pharmacy practice and science at the University of Maryland School of Pharmacy.

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