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Federal Discrimination Continues Against Oregon’s Efforts to Treat Opioid Crisis
Greg Garcia ND, LAc
A recent Centers for Disease Control report shows the number of drug overdose deaths in Oregon as of June, 2017 decreased to 480 from 521 the previous 12 months. The decrease in drug overdose deaths is also true across several other Western states including California, Washington, and Utah. The death rate from drug overdoses in many other parts of the country, however, continues to increase. According to their report over 66,800 people died in the United States during the same timeframe from drug overdose. By all accounts we are living in a public health crisis.
While there is no analysis of why there was a decrease in Oregon, several factors may be helping lower Oregon’s death rate. Efforts to increase the availability of Naloxone, a life-saving medication that temporarily reverses opioid overdose effects, is one factor. Naloxone is being used by more police agencies, social service agencies, as well as by needle exchanges such as Outside In which offer Naloxone training to all needle exchange consumers.
Other factors include the Oregon Prescription Drug Monitoring Program, started in 2011, which allows practitioners, pharmacists, and recently medical directors, to monitor patients who may be diverting or misusing pain prescriptions. Early detection can support appropriate intervention measures or referrals for treatment. Medical institutions are also working to lower the amount and frequency of opioid prescribing while encouraging alternative treatments for pain patients.
Even so, over 2.5 million opioid prescriptions were filled in Oregon during the first 9 months of 2017. The number of opioid prescriptions is significant because the Oregon Health Authority notes Oregon has one of the highest rates of prescription opioid misuse in the nation.
Improving our treatment of addiction, or the more preferable term to use, substance use disorders, necessitates an integrated community response. The opioid crisis in Oregon makes it all the more remarkable the continuing and ongoing discrimination imposed by the Drug Enforcement Agency and SAMHSA against naturopathic physicians in Oregon.
Federal discrimination against naturopathic physicians is also ironic. Naturopathic physicians in Oregon can legally prescribe every Scheduled narcotic except one. The one exception is for buprenorphine, known by it’s trade names Suboxone or Zubsolv, which is the only opioid medication available for office-based treatment of patients with substance use disorders.
Buprenorphine has been approved to treat opioid disorders since 2000. Like methadone, buprenorphine is an opioid medication but without some of the risks inherent with methadone. Unlike methadone, buprenorphine was intended to be prescribed out of a doctor’s office rather than requiring patients to go to specialized clinics.
In order to prescribe buprenorphine, however, the Drug Enforcement Agency required doctors to obtain specific training and apply for a “waiver” beforehand.
In 2006, I applied for a Drug Enforcement Agency waiver after completing my buprenorphine training. As a licensed naturopathic physician, I had been working onsite at Multnomah County’s drug court agency for over 10 years and directly treated or clinically supervised several thousand patients during that time. Even with my certificate of training, however, my waiver request was denied.
The reason given was I was not a medical doctor, the only profession approved by the Drug Enforcement Agency to use buprenorphine at that time and despite buprenorphine being approved for use by the Oregon Board of Naturopathic Medicine. Their reasoning focused on my status as a mid-level prescriber, a designation they pre-determined for my profession.
As part of the Comprehensive Addiction and Recovery Act (CARA) signed into law in 2016 midlevel prescribers were given the right to prescribe buprenorphine with appropriate training. According to the Drug Enforcement Agency mid-level prescribers include nurse practitioners, physician assistants, and naturopathic physicians.
I obtained a second certificate in 2017 through training programs offered by FamilyCare and the Oregon Pain Guidance organization. Sitting near me were medical doctors, some still in their residency, as well as other mid-level prescribers. Presumably they will all receive their waiver.
Once again, however, I’m denied a waiver by the Drug Enforcement Agency and SAMHSA. If I was licensed as any other qualified profession in our state, including other mid-level prescribers, I could be proudly standing alongside them with my waiver. After more than 20 years of experience in the field of substance use disorders including residential and outpatient treatment settings I continue to be unable to utilize this valuable medication for treatment. There is no word to describe the behavior of these federal agencies other than professional discrimination.
Practitioners who work in the substance use field know the disorder is complex and an integrated, comprehensive team approach is our best response. Oregon can no longer afford well qualified professionals be denied a waiver.
Greg Garcia ND, LAc has been a licensed naturopathic physician since 1988 and is a former professor at NUNM. He serves as medical director for several drug and alcohol programs in Multnomah and Marion County.
Feb 14 2018
Greg Garcia ND, LAc
A recent Centers for Disease Control report shows the number of drug overdose deaths in Oregon as of June, 2017 decreased to 480 from 521 the previous 12 months. The decrease in drug overdose deaths is also true across several other Western states including California, Washington, and Utah. The death rate from drug overdoses in many other parts of the country, however, continues to increase. According to their report over 66,800 people died in the United States during the same timeframe from drug overdose. By all accounts we are living in a public health crisis.
While there is no analysis of why there was a decrease in Oregon, several factors may be helping lower Oregon’s death rate. Efforts to increase the availability of Naloxone, a life-saving medication that temporarily reverses opioid overdose effects, is one factor. Naloxone is being used by more police agencies, social service agencies, as well as by needle exchanges such as Outside In which offer Naloxone training to all needle exchange consumers.
Other factors include the Oregon Prescription Drug Monitoring Program, started in 2011, which allows practitioners, pharmacists, and recently medical directors, to monitor patients who may be diverting or misusing pain prescriptions. Early detection can support appropriate intervention measures or referrals for treatment. Medical institutions are also working to lower the amount and frequency of opioid prescribing while encouraging alternative treatments for pain patients.
Even so, over 2.5 million opioid prescriptions were filled in Oregon during the first 9 months of 2017. The number of opioid prescriptions is significant because the Oregon Health Authority notes Oregon has one of the highest rates of prescription opioid misuse in the nation.
Improving our treatment of addiction, or the more preferable term to use, substance use disorders, necessitates an integrated community response. The opioid crisis in Oregon makes it all the more remarkable the continuing and ongoing discrimination imposed by the Drug Enforcement Agency and SAMHSA against naturopathic physicians in Oregon.
Federal discrimination against naturopathic physicians is also ironic. Naturopathic physicians in Oregon can legally prescribe every Scheduled narcotic except one. The one exception is for buprenorphine, known by it’s trade names Suboxone or Zubsolv, which is the only opioid medication available for office-based treatment of patients with substance use disorders.
Buprenorphine has been approved to treat opioid disorders since 2000. Like methadone, buprenorphine is an opioid medication but without some of the risks inherent with methadone. Unlike methadone, buprenorphine was intended to be prescribed out of a doctor’s office rather than requiring patients to go to specialized clinics.
In order to prescribe buprenorphine, however, the Drug Enforcement Agency required doctors to obtain specific training and apply for a “waiver” beforehand.
In 2006, I applied for a Drug Enforcement Agency waiver after completing my buprenorphine training. As a licensed naturopathic physician, I had been working onsite at Multnomah County’s drug court agency for over 10 years and directly treated or clinically supervised several thousand patients during that time. Even with my certificate of training, however, my waiver request was denied.
The reason given was I was not a medical doctor, the only profession approved by the Drug Enforcement Agency to use buprenorphine at that time and despite buprenorphine being approved for use by the Oregon Board of Naturopathic Medicine. Their reasoning focused on my status as a mid-level prescriber, a designation they pre-determined for my profession.
As part of the Comprehensive Addiction and Recovery Act (CARA) signed into law in 2016 midlevel prescribers were given the right to prescribe buprenorphine with appropriate training. According to the Drug Enforcement Agency mid-level prescribers include nurse practitioners, physician assistants, and naturopathic physicians.
I obtained a second certificate in 2017 through training programs offered by FamilyCare and the Oregon Pain Guidance organization. Sitting near me were medical doctors, some still in their residency, as well as other mid-level prescribers. Presumably they will all receive their waiver.
Once again, however, I’m denied a waiver by the Drug Enforcement Agency and SAMHSA. If I was licensed as any other qualified profession in our state, including other mid-level prescribers, I could be proudly standing alongside them with my waiver. After more than 20 years of experience in the field of substance use disorders including residential and outpatient treatment settings I continue to be unable to utilize this valuable medication for treatment. There is no word to describe the behavior of these federal agencies other than professional discrimination.
Practitioners who work in the substance use field know the disorder is complex and an integrated, comprehensive team approach is our best response. Oregon can no longer afford well qualified professionals be denied a waiver.
Greg Garcia ND, LAc has been a licensed naturopathic physician since 1988 and is a former professor at NUNM. He serves as medical director for several drug and alcohol programs in Multnomah and Marion County.
Feb 14 2018
