DATA 2000 and Opiate Addiction

Background/Purpose:  Opiate addiction is a serious national problem costing millions of dollars and tens of thousands of lives every year. The Drug Abuse Treatment Act (DATA) of 2000 changed the treatment paradigm by permitting physicians via waiver to prescribe FDA approved opiate medications for the treatment of limited numbers of addicted patients in an office setting. In 2002 the FDA approved one medication, buprenorphine for use by waivered physicians.

            The purpose of this exploratory descriptive study is to examine the impact of DATA 2000 on the treatment admissions of narcotic addicts in Kentucky. Since buprenorphine treatment has been available both in an office-based treatment setting, as well as in other public and private treatment facilities for a decade, some effects on treatment admissions are expected. This study examines trends in treatment admissions against the backdrop of availability and utilization of buprenorphine as a treatment for opioid addiction.

Methods: The main source of data for analysis is the Treatment Episode Data Set – Admissions (TEDS-A). This is a population-based dataset, whereby information is collected annually on every admission to a treatment facility receiving any public funding. In Kentucky, 48% of 320 treatment facilities report data to TEDS-A. TEDS-A contains data from Kentucky for 1997 – 2012. Supplemental data from the Substance Abuse and Mental Health Services Administration and the National Survey of Substance Abuse Treatment Services are also used to illuminate trends and provide context for findings.

            Secondary data analysis  allowed for examination of trends in annual counts by year. The variables examined were numbers of admissions reporting heroin use, numbers of admissions reporting other opiate use, and first time  treatment admissions. Other opiates includes codeine, hydrocodone, hydromorphone , meperidine, morphine, opium, oxycodone, buprenorphine and any other drug with morphine-like effects.

Results:  Heroin and other opiates are increasingly reported as drugs of choice in Kentucky’s publicly funded treatment facilities, despite the addition of the office-based treatment paradigm. In 1997 less than 1% reported heroin use at intake. By 2008, 5 years after DATA 2000 was in effect, heroin use at admission had risen to 3%. In 2012, 15% of admissions involved heroin as a drug of choice. In 1997 persons reporting other opiates use comprised 3% of admission and in 2008, these numbers rose to 28%. By 2012, it has reached 40% of treatment admissions. 

New substance abusers continue to stream into publicly funded treatment. In 1997, the percentage of first time admissions was 67%, in 2005, 47% were first time admissions, and in 2012 60% of all admissions were new addicts.  In 2005, 19 doctors were waivered to provide buprenorphine treatment to 570 patients; by 2012 that number rose to 289 doctors approved to treat 19,100 patients.  Those patients receive treatment and more treatment slots are  needed.

Conclusions/Implications:  It is clear that implementation of DATA 2000 has  not reduced opiate admissions in publicly funded treatment. Removal of the patient limits imposed on physicians by the waiver should be considered in order to meet the rising treatment need.