The following open letter was emailed to leading Maine political leaders who represent the state in Congress… comments welcome

Congratulations on your letter to SAMSHA urging that HHS Secretary exercise authority to waive 30-patient limit on prescribers of BUPRENORPHINE. I wonder, though, if your office has assessed impact of the recent congressional bill (109-56) waiving the 30 patient per GROUP limit. Hopefully it's expanded patient access to care, but has it?

As a fervent advocate of opiate agonist treatment I applauded 109-56 and also your current effort to remove individual doctor limit as well. But would this really make much difference? You estimate Maine would need additional 667 certified docs to meet the need - I guess roughly 20,000 opiate dependent citizens. There are 33 Maine physicians now certified - to meet even a quarter of the addicted population, these 33 would have to prescribe to roughly 150 patients each - clearly unlikely. So what would the expected impact be of removing the individual physician limits?

More is needed than lifting the physician-patient limit. I urge you to demand of Federal government that it explore promptly what alternatives exist, and move to implement those that are promising. Much can be done - France was able to increase patients in treatment from 0 to over 85,000 in about 7 years - overwhelmingly through generalist community-based practitioners. Community docs also are the primary source of care to some 65,000 methadone- and buprenorphine-maintenance patients. Why can't USA achieve similar expansion?

Thank you. Robert Newman MD, MPH