Why Is There a Patient Cap on Medication Used to Treat Heroin Addicts?

Photo by Joe Loong CC-BY 2.0

At Guernica, Lucas Mann (who lost his brother to heroin addiction) writes on why abstinence and methadone don’t work and how doctors are failing in their fight against arbitrary, DEA-enforced patient caps on buprenorphine — a promising treatment for heroin addiction.

Curran began prescribing in 2002. He was stunned by the results, and so were his patients. The first patients went out and told others, and there were many others. But he wasn’t supposed to treat an endless supply; at the time, a doctor was capped at thirty buprenorphine patients in any given year. Curran hit his cap in less than a week. In a matter of months, he was looking at over 700 people in need. He didn’t know what to do. He tried to get local methadone clinics (who were authorized to dispense buprenorphine) to take his patients, but they were unwilling to use anything but methadone.

“The people kept coming,” he tells me. “It was like Schindler’s List.”

It’s hard to turn away someone prostituting for drug money because of a number you’re not supposed to cross. And this is where the Hippocratic Oath comes in. He prescribed to all of them.

“They told me I was the biggest violating doctor in America,” he says.

When the DEA agents—young blonde women in professional attire, like pharmaceutical reps—first showed up at his office in 2005, it was a surprise. The waiting room was full, and his patients watched as the officers told him to start letting people go.

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