Officials push for more medication-assisted opioid treatment in N.H.

  • Dr. Ruth Potee of Valley Medical Group in Greenfield. Mass., holds a single dose of Suboxone in her office. Greenfield Recorder file

  • Dr. Sally Rossignol, left, talks with Rep. Ann Kuster, D-NH, after a roundtable discussion on opioids April 9, 2018. Ethan DeWitt—Ethan DeWitt

Monitor staff
Published: 4/9/2018 10:17:56 PM

It’s become a central component of the state’s opioid response. People in the throes of substance abuse disorder are given new medications, targeted to cut off any chemical enjoyment of the drugs doing them harm. Combined with peer support, therapy and sheer willpower, “medication-assisted treatment” can give those suffering addiction a better life – and let them hold onto it.

But even with the growing popularity of Suboxone, the most commonly used “blocking” pharmaceutical, New Hampshire faces an elemental problem: physicians. The number of doctors and nurses actually trained to prescribe the medications is far from enough, advocates say.

“I thought it would be, you know, like, everyone’s going to do this,” said Molly Rossignol, a Concord family medicine doctor, speaking on the treatment. “And not everyone wants to do this.”

Physicians of all stripes are able to undergo trainings – typically eight hours long – in order to treat patients with substance abuse. But many doctors, already overloaded within their own field, are wary of the extra commitment, Rossignol said Monday.

“It’s hard to do primary care,” she said. “We’re asked to see more and more patients, then when you add in ‘Well, gee would you see someone with an opioid use disorder?’ I’ll be the first to admit it: That’s a complex patient.”

Now Rossignol and others are seeking to challenge that instinct, spreading to hospitals around the state to offer the trainings and boost the ranks. In the last year, the New Hampshire Medical Society has trained 210 medical professionals, according to Jim Potter, executive vice president; two thirds have been physicians. In the coming months, the organization will swing through Wentworth-Douglas in Dover and Dartmouth-Hitchcock in Lebanon, Potter said.

It’s an effort that resonates with Rossignol, who in 2014 paused her practice of 14 years to take a yearlong fellowship in addiction medicine at the University of Wisconsin. Now back in Concord, she has facilitated trainings, helped instruct medical students and advocated for expansion of the treatment approach.

And it’s one that’s catching on; the Dartmouth Geisel School of Medicine is seeking to incorporate medication-assisted treatment into the four-year curriculum for all students, according to Matthew Houde, vice president of government relations at Dartmouth-Hitchcock.

For Potter, just carrying out the training sessions is a feat.

“We’ve been pulling this together with bubble gum and Band-Aids to find the funding for this, but I see this as a sustained effort for at least three to five years,” he said.

New federal legislation is looking to assist. At a Concord roundtable Monday centered on opioid abuse, Rep. Annie Kuster, D-N.H., presented “CARA 2.0,” a bill she’s sponsoring to help provide for the trainings. Styled after the 2016 Comprehensive Addiction and Recovery Act, the new legislation would provide around $1 billion in targeted funding. And it would also include measures lifting restrictions for medication-assisted treatment.

By default, American physicians are limited to 30 patients to which they can prescribe buprenorphine, a key ingredient of Suboxone. Any higher and they must apply to the Substance Abuse and Mental Health Services Administration in Washington, D.C., to get a waiver to treat up to 100 patients. Those who have treated 100 patients in a year can then reapply to treat 275.

Nurse practitioners and physician assistants, meanwhile, are still capped at lower amounts.

The federal bill, co-sponsored by Reps. Marsha Blackburn, R-Tenn.; Tom MacArthur, R-N.J.; and Tim Ryan, D-Ohio, would wipe away those caps and allow states to set their own limits. And it would broaden the availability to certified registered nurse anesthetists, clinical nurse specialists and nurse midwives.

Kuster said allowing for that broader base of trained medical professionals would encourage a more robust response, across medical fields.

“What we need is more people with the specialized training and then for them to have the full cadre of health care providers, mental health providers, treatment providers, social workers.” she said. “The most effective programs bring this all together.”

Meanwhile, for providers, a question looms: money. The omnibus spending bill signed by the president in March included $3.3 billion for opioid relief – $142 million of which was set aside for hard-hit states like New Hampshire. Some around the table, representing recovery centers, hospitals and advocacy groups, argued that more is needed in the Granite State to tackle “upstream” issues – the factors and situations that lead to addiction.

Exactly how the $142 million is to be divided up, and how many states will even receive it, is still being negotiated.

Addressing the room, Kuster said the money secured last month is a start. But, she added, “Our goal is much more than that.”

(Ethan DeWitt can be reached at, or on Twitter at @edewittNH.)

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