What did the 2018 federal opioid law set out to do?
In November 2018, I spoke with Bob Coates, the founder and CEO of SyMedica, a health care consulting company. At the time, he was also working in Washington, D.C., as the health care consultant for a lobbying firm, and he had been following the federal opioid bill closely as it moved through Congress.
We talked about what the bill, known as H.R. 6 or the SUPPORT Act, meant for doctors and patients. We covered grants, prescribing limits, family involvement, safe disposal of old medications, following the law, and harm reduction.
This is an archive episode, recorded when the show covered addiction and recovery broadly. The details describe the law as it stood at that moment.
Why did Congress describe the opioid epidemic as a family issue?
At 1:02, Bob called the bill a marvelous beginning, and he was careful to say it was only a beginning. What struck him most was that Congress had framed opioid use as something that affects whole families, economically, spiritually, and in their relationships.
At 2:43, I said that from where I stood in health care, not enough had been done. I mentioned pilot programs at hospitals that start medication for opioid dependence in the emergency room and then continue it. Bob agreed that the approach was spreading across health care.
How were hospitals and states changing opioid prescribing?
At 3:17, Bob described a Florida hospital system that had announced it would stop using opioids for pain after surgery. He understood that the system was studying the outcomes.
He then explained the new Florida law on acute pain. A prescription for acute pain was limited to a few days unless the prescriber documented medical necessity, which allowed a longer supply. It did not affect people with chronic pain.
Still, he saw a practical problem. In his view, a patient just home from the hospital and still in pain would find it very hard to get back to the office every few days, since the prescriber had to see the patient in person each time.
How can a small practice take part in new federal funding?
At 6:00, I asked what a doctor in a small practice, who is not much of a business person, could do to get involved. Bob explained that most of the grant money would flow through the Department of Health and Human Services, and that the agencies were still deciding how the grants would work.
He had served as a grant reviewer for SAMHSA, the Substance Abuse and Mental Health Services Administration. In his experience, many applications are first screened by computer for the key terms in the legislation, and an application that misses them is rejected with little further review. So, he said, a strong application takes months to prepare, and a provider also needs a SAM registration before the federal government can pay them. He also noted a provision allowing telemedicine evaluation and prescribing by nurse practitioners and physician assistants as well as physicians.
What did the bill change for doctors who prescribe buprenorphine?
At 11:03, I explained why this mattered to me. Many patients reached out who could not afford care or medication, the programs that existed had very little space, and a doctor could only take on so many patients at low or no cost.
Bob answered with what he called good news. From 11:36, he explained that the bill raised the limit on how many patients a physician could treat with buprenorphine at one time.
Unfortunately, he said, not all of the overdose deaths came from prescriptions, since street drugs played a large part. He warned that street fentanyl doses are so unpredictable that a very small amount can stop a person’s breathing almost at once. He also described grants, sponsored by Senator Lamar Alexander, to build local networks of care for people who could not afford it, and tuition reimbursement for clinicians who agree to work in areas short of health professionals.
Why does family involvement matter in recovery?
At 16:39, I recalled an earlier episode with Orlando Castro, who works with adolescents. When I asked him to design the ideal program, the one thing he focused on was involving the family. I said we need to emphasize family therapy and family involvement.
Bob, a licensed marriage and family therapist, agreed. At 17:16, he said every legislator who spoke on the issue had called it a family problem. Interestingly, he added that in his field it only takes one person to make a family, and colleagues or neighbors can matter as much as relatives.
What should people do with leftover pain medication?
Bob raised a warning about old prescriptions. In his account, many homes have opioid pain medication left in the medicine cabinet because a dentist or family doctor gave a far larger supply than the problem needed, and young people sometimes take it from a parent or grandparent to experiment.
At 21:22, I asked whether there is a year-round way to get rid of it. Bob said the fire station is often the easiest place to go, almost at any hour. In fact, he stressed that no questions are asked and no one is investigated.
What does intent to comply mean for a medical practice?
At 23:00, I asked whether his company also helps practices follow the rules on things like unused medication. Bob said it does, including continuing medical education and audits of clinical records.
From 23:14, he explained a legal idea he wanted listeners to know, called intent to comply. In his understanding, a clinician who can clearly show they are trying to follow the current laws and rules is usually not treated as having committed a felony, although it could still become an administrative licensing matter. He said he had heard the United States Attorney General make that point in several administrations.
Where does harm reduction fit in?
At 25:16, I said I believe in harm reduction. I said that naloxone, the medication that can reverse an opioid overdose, also sold as Narcan, should be everywhere, on every wall where there is a fire extinguisher. I also said I had once been against supervised consumption sites, but had come to think they could be a good thing, with drug testing, an attendant, and information about where to find help.
Bob agreed. At 26:08, he said the bill addressed access to naloxone and that some states required a naloxone prescription alongside certain opioid prescriptions. However, the Department of Justice took a negative view of supervised sites at the time. Yet he expected common sense to prevail.
At 30:13, I suggested such a site could also be a place to observe someone starting buprenorphine for the first time. That matters when a busy doctor cannot sit with every patient, or when care is given by telemedicine.
Was the opioid bill a bipartisan effort?
At 30:59, Bob said he had never seen such a strong bipartisan issue in all his years as a lobbyist and clinician. Only one senator voted against it, he said, and not because he opposed the goals. That senator felt that regulating medical practice belonged to the states.
Who is Bob Coates?
Bob Coates is the founder and CEO of SyMedica, a health care consulting company that works on regulation, grants, and continuing medical education. He is a licensed marriage and family therapist in Virginia, a clinical member of the American Association for Marriage and Family Therapy, and a former grant reviewer for SAMHSA. At the time of this conversation, he was also a health care consultant to a lobbying firm in Washington, D.C.
What can listeners take away from this conversation?
Laws and funding shape who can get care, and in 2018 the federal government was trying to widen that access. Of course, policy only helps when it reaches patients. Safe disposal of old medication, naloxone within reach, families who are involved, and doctors who are free to treat more people are all part of that.
How do I approach this today?
My thinking has kept developing since this conversation was recorded. Today my practice is built on one idea that runs through all of it: when the body has adapted to a substance, the safest way off is usually gradual, with the smallest steps the person’s nervous system can tolerate. Physical dependence is not addiction.
For opioid dependence I prescribe buprenorphine, which steadies the body so a person can rebuild their life without the cycle of withdrawal. Visits are monthly, or weekly when needed. Some people stay on it for a long time, and that is a legitimate choice. Others later taper slowly, using the same gradual approach I use for every other medication.
I prescribe in Florida only.
Call 911 or go to an emergency department if there is a seizure, confusion or hallucinations, or thoughts of self-harm. For thoughts of suicide or any mental health crisis, you can also call or text the 988 Suicide and Crisis Lifeline.
This page is educational. It is not medical advice, and listening to the episode or reading this page does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
Full transcript
A note from Dr. Leeds: my guests speak from their own experience and expertise, and the terminology they use is their own. Whatever the topic, this show holds to one distinction: physical dependence on a prescribed medication is not addiction. This transcript is educational content, not medical advice, and nothing here creates a doctor-patient relationship.
Read the full transcript (36 minutes)
Dr. Mark Leeds [00:09] Welcome to The Rehab on the Mental Health News Radio Network. I am Dr. Mark Leeds and I will be your host. Join me in exploring the world of addiction treatment. How can we improve the ways that we help individuals to overcome addiction? The goal of treatment is to save lives and help people to get back on track to a path towards success and happiness in life. Bob Coates, you are the CEO and founder of SyMedica, and you’re a consultant, and you do many things, and I know currently you’ve told me that you’re working as a lobbyist in Washington, D.C. With LobbyIt, and specifically with addiction treatment. And you’ve told me a little bit about the current Senate bill.
Bob Coates [01:02] Absolutely, Dr. Leeds. It is a joy to see the progress that Congress has made this year. The culmination of dozens of hearings in both the House and the Senate has resulted in what I’ll call a combined reconciled House Bill 6, and that’s referred to as SUPPORT in all capital letters. It is a marvelous beginning of how we’re looking toward dealing with the opioid crisis nationwide, yet always careful to add to that this is only a beginning. What we’re seeing is that there are and have been extensive other opioid-related legislation that is pending before both the House and the Senate. I think that it’s very important to realize that Congress this year has taken an unusual step forward in identifying the opioid crisis as a disease affecting families. Therefore, it is recognized as a family issue as well. Because in my clinically experience, and I know Dr. Leeds and yours, families are tremendously affected by a loving family member who, whether it’s the immediate family or family of origin or an extended family, they’re affected as a whole, both economically, spiritually, interpersonally, and what is referred to as biopsychosocial impact.
Dr. Mark Leeds [02:43] That’s great that the federal government is doing something. The perspective of the public and, from my point of view, in health care, it clearly seems like not enough has been done so far. I know that there’s been some pilot programs. For example, there was a program started at Yale New Haven Hospital where they start medication-assisted treatment in the emergency room and then continue it. And there’s been some other small pilot programs at JFK Medical Center here in Palm Beach, Florida. They have a similar program. And I believe a new program similar to this also at Memorial Hospital here in Hollywood has started recently.
Bob Coates [03:17] Right. It’s expanding in many aspects of health care. Of note, though, is that we’re seeing trends that in the hospital setting postoperatively, which is very much a departure from 90 day program, is that like, for example, Florida hospital system is not using opioids in post-op recovery.
Dr. Mark Leeds [03:40] They’re preferring or not using opioids at all for dealing with postoperative pain?
Bob Coates [03:45] That’s right. It’s very interesting because no further clarification was given whether or not it’s postoperatively for cardiac interventions or orthopedic or what have you. It was just pretty much a clear statement that was made, I’m guessing, Dr. Leeds, about two months ago, two, three months ago. They’re using less invasive issues. I think that this is going to be an interesting outcome because it was inferred that they’re doing outcome studies as to the application of this protocol change. It still doesn’t remove the responsibility for the surgeon to take responsibility for 90 days post-operative for complications, but it does tremendously affect the modalities of pain amelioration and palliative care. I want to be careful to note that in looking system-wide in how health care organizations are treating the opioid issue, there is, as you know, in Florida law, effective July 1st, a three- or seven-day supply for acute pain. It does not affect the chronic pain patient, but acute pain is those presentations that are usually from a recent injury or a condition that is historically not been found in the patient’s comorbidities or their requirements for treatment. The way the law works in the state of Florida is that there’s an automatic three-day limit unless the prescriber indicates that there’s to be, by stating on the prescription, medical necessity for acute pain that would extend it to seven days. When you think about it, a patient who has just been discharged from the hospital or a rehab center that has continuing pain, it’s very difficult for them to ambulate back into an automobile to the doctor’s office for every three or seven day fulfillment. And the law says that the provider has to lay eyes on the patient. You just can’t sign a script and just leave it for someone to pick up.
Dr. Mark Leeds [06:00] You’ve talked about the Senate bill and there’s going to be funding for new programs. Now, suppose a doctor who has a small practice and isn’t really a business person and doesn’t know what step to take next, but they want to get involved in this program, they want to be part of this, what can they do as a next step?
Bob Coates [06:18] Excellent question, Dr. Leeds. SyMedica has a history of working out of our consulting side in discovering grants. And in this particular, House Bill 6, there is a total of about $8.4 billion in monies that go to both state programs and also commercial providers and institutions. The decision as to what particular department or agency of the federal government that will attend to the various opportunities for grants has not been completely decided. But this we know is that the Department of Health and Human Services is the prevalent gatekeeper, if you will, at the level of the secretary to determine what various agencies in HHS or for that matter, even the Department of Labor has some actions that are underway and as well the Department of Justice. It’s to be expected that President Trump will sign this bill within two weeks. I just checked yesterday with the Senate Health Committee, that’s the Committee for Health, Education, Labor, and Pensions, and the senior staffers were sharing with me that it’s probably going to be signed in two weeks. And with that, they are currently negotiating with the various agencies to determine the pathways of grants. SyMedica can help anyone, especially a physician in a solo practice, to expand their visibility and promote their viability in delivering medication-assisted therapy, such as suboxone or buprenorphine. And also, there is a caveat in the law that allows for telemedicine evaluation and prescribing of the medication-assisted therapy to include not only nurse practitioners but also physician assistants. Now, we are working together in my lobbying work. I’m the health care consultant for a group in D.C. Called LobbyIt.com. And these are attorneys who are exceptional in the field of lobbying the various agencies as well as the legislators themselves. And combined with SyMedica, and that’s spelled S-Y, capital M-E-D-I-C-A, we can help a provider or an institution to apply for the appropriate grant. We do the research as to who is processing the various grants, the requirements. And usually, Dr. Leeds, this takes about a three-month period of time to put together a high-functioning grant application. Over the years, I have served as a grant reviewer for SAMHSA, the Substance Abuse Mental Health Agency, under HHS. There are strict guidelines that I’ve been taught in evaluating grants, and so we kind of transfer that information over to our clients in the lobbying arena so that they can provide the aspect of key word content. Initially, many of the grants go through an intellectual process of a computer, so to speak, that looks for the buzzwords that’s found in the legislation. And if the grant doesn’t in particular address those key requirements, it is rejected initially with very little further review. So the blessing here for the provider is that we stand ready as of today to help the gathering of information that a provider may have. And we know the requirements of getting what is called a SAM number. That is a number that is a system apparatus to where providers get paid. Without that particular relationship with the government in a formal way, by way of the SAM application and granting the number, you can’t do business with the federal government. It is a very complex issue. I have done a large number of grant writing myself, but it’s always good to have other professionals such as these attorneys that come from a history of employment with agencies relative to the healthcare profession assist in these application processes.
Dr. Mark Leeds [11:03] And this sounds like an incredible opportunity because a lot of patients reach out to me that they cannot afford treatment, they cannot afford the medication and therapy, and they need assistance. And the programs that are currently out there have very limited space. It’s very difficult because of the limitation of the number of patients that we can carry that if a doctor dedicates their practice to addiction treatment, and a practice for addiction treatment really should be fully dedicated if possible to give the best care, it’s hard to be able to take on too many patients at no cost or low cost because we’re very limited.
Bob Coates [11:36] Well, I’ve got some very good news for you, Dr. Leeds and your colleagues. The first element I wish to address is that historically the use of medication-assisted therapies such as buprenorphine on the market known as Suboxone or Subutex. Initially, it was limited to 50 patients at any one given time. Then it was increased to 100 based on the experience of the practitioner. Dr. Leeds, this bill increases the number that a physician can have in their practice to 275 patients because there are so many people that have been affected by this opioid crisis. If you consider that in 2017 nationwide, there were 72,000 overdose deaths from narcotics. Now, I am not saying those were all prescription overdoses from prescribing physicians because they weren’t. They’d also include the illegal importation of Schedule I drugs such as heroin and a Schedule II drug fentanyl, which comes from either Mexico or China through the U.S. Mail. And then, of course, you’ve got various and sundry street drugs out there that combined with these drugs, such as benzodiazepine like alprazolam, it can create a disastrous outcome. The street dosages of fentanyl, for example, are unbelievably unknown to the extent that just a very small amount can create almost an immediate respiratory issue that results in death. We also have the issue with diversion of medications. The second piece of good news I think that I need to share is that not only do you have an increase in the number of patients that you can see with the medication-assisted therapy, but there are outright grants. I know that a very beloved and dear Senator Friend of mine, Senator Lamar Alexander of Tennessee, which is my home state, sponsored a very progressive bill that creates what are called comprehensive opioid recovery programs. And these are $10 million grants that allows for a state jurisdiction by way of even commercial professionals as yourself to create a network in their locality to treat patients who are economically disadvantaged. So I believe that it’s a true opportunity right now that in my lifetime, that I’ve been in practice since 1978, Dr. Leeds, I’ve never seen such a great opportunity right now for professionals. And what is more exciting is that I’m just completely thrilled that there are people such as Dr. Mark Leeds out there that has a profound grasp of this healthcare space in the lobbying arena that understands not only the need, but you experience the need 24 hours a day with your patient alone. And I can’t help but to imagine you get phone calls from people who say, Dr. Leeds, I need help, but I don’t have any money. And at that point, being the conscious provider I know that you are and myself, we want to try to do our best to help those individuals and also families to get the treatment necessary to create a healthy milieu for life for them. There’s a lot of good news going on. We are intimately knowledgeable about where to go to find out a grant specifically for virtually any type of provider. Now, there is another financial impact here that I don’t want us to overlook. It has been identified that in the United States there is a severe shortage of addiction professionals at the mid-level area of licensed addiction professionals, licensed mental health care professionals in Florida and other states. Jurisdictions are called licensed professional counselors, licensed marriage and family therapists that are able to get tuition reimbursement if they elect to spend as little as three years in what is called an MUA, medically underserved area or a HPSA area, which is a health professional shortage area. You will be surprised that, for example, even the city of Miami will have areas that are medically underserved and health professional shortage areas. So the tuition reimbursement doesn’t only apply to mid-levels. It also goes to physicians themselves who will agree to serve that population in a formal agreement that results in tuition reimbursement.
Dr. Mark Leeds [16:39] That’s excellent. Now, one thing you mentioned reminded me of another episode of this show where my guest Orlando Castro, who works with adolescents at Larkin Hospital, I had asked him if he could design the perfect program to help young adults and teenagers to overcome addiction, if he could create a program with unlimited funds and incorporate anything that he wanted to. The one thing that he focused on was more involvement of families, that the most important thing is involving the family to help the addict to recover. And you mentioned the same thing. And I think we need to really emphasize the importance of therapy, family therapy, family involvement.
Bob Coates [17:16] Oh, absolutely. I received 80% of my supervision toward licensure in the Commonwealth of Virginia. I’m licensed in that Commonwealth. In the mid-80s from family practice physicians who also were credentialed, one in particular, in psychiatry. And as being a marriage and family therapist, I am a clinical member of the American Association for Marriage and Family Therapy. A neighbor of mine in my Alexandria, Virginia practice, and I approached them early on this summer about helping marriage and family therapists to have the academic preparation as well as the practical clinical supervision and addiction setting. The reason I did so is that I realized that because every single legislator, both in the House and the Senate, that addressed the issue of the opioids mentioned it was a family issue. So doesn’t it really stand to reason to have someone as a licensed marriage and family therapist who is acutely aware, well-trained, and prepared educationally and via supervision by a physician or another clinical supervisor at their level toward treating addiction for family systems. Now, you may think that a family must be something like two partners with children and grandparents or what have you. Interesting to note that we as a marriage and family therapist say it only takes one person to make a family. There may not be biological family members, but their colleagues and their individuals in their neighborhood that they would consider just as important as a blood relative. So we need to keep that in mind, that no one is excluded when you say, or when we indicate that it is a family problem, because it does affect the public trust, the public fiscal trust, as we go about trying to alleviate this crisis. I know that even grandparents are sensitive and are involved as well. And may I make a statement of precaution here? Oftentimes, in the recent past, providers, even for dentistry or family practice, have given a 30-day supply of, say, a hydrocodone or a Percocet for maybe a dental problem that really ought to be limited to three or four days’ worth of treatment. So in many homes, you will find that there are prescriptions in the medicine cabinet that have been there for years, but they’re very, very dangerous. And a lot of times, young adolescents are under a peer pressure to get involved in experimental behavior with medications. And so it’s very sad to report that many of those deaths are the result of individuals who have diverted the medications of a parent or more likely a grandparent who is not as observant at times for use in, say, weekend parties or what have you, or just plain experimenting. So it’s very important to take any kind of narcotic that has been prescribed, and once that pain is under control and it doesn’t become a chronic issue, it’s very important to have those narcotic medications destroyed in a professional and responsible manner. And that’s why we have usually in most every city in Florida, at least twice a year medication take-back initiative sponsored by the local Department of Health and, as well, law enforcement.
Dr. Mark Leeds [21:22] Is there a year-round medication take-back program? Like, could a person go to their local, like to the fire station, maybe?
Bob Coates [21:30] Absolutely. Yes. The fire station is suggested to be the number one place that you can go almost 24-7 and take expired medications or medications that are no longer necessary in the home. And the fire department knows exactly how to take custody of those and to provide that patient with evidence that they have been conscientious and they list the number of medications, actual dosages that have been reported. And this is a very safe process because no one is investigated for turning in medications or anything like that or no questions are asked about where you got them or what have you. They kindly and respectfully take them back and destroy them appropriately by a firmly written protocol. So there’s no risk involved in participating in that medication take-back process. You can also approach your family doctor, and they will give you advice. And practically, in most cases, they will use their own protocol. For example, SyMedica has actually owned individual pain management clinics, family practice clinics, rural health clinics, and behavioral medicine. And we have a written protocol that we freely extend to any provider who wishes to have it available in their own practice.
Dr. Mark Leeds [23:00] So you do also provide consulting services for practices, small and large, to help them with compliance and having procedures to handle various things like what to do with unused medication and other kinds of issues that come up?
Bob Coates [23:14] Oh, absolutely. In fact, SyMedica is nationally highly respected for its compliance initiatives. Everything from educating providers as we are a provider of continuing medical education through the Florida Division of Medical Quality Assurance and have been since 1997. But our company has actually audited the clinical records of well over 1 billion patients who are Medicare and Medicaid recipients so that we can help the practice understand their outcomes, how effective their treatment is for their patients. And we also serve in just any state as a compliance officer for those responsible pain physicians and licensed pain treatment centers that want to be in full compliance with the law. There is a concept I would like to share with your listeners, Dr. Leeds, and that is intent to comply is pretty much a legal term that says that if a health care practitioner can thoroughly and completely demonstrate that they are intending to comply with the current statutes, laws, and regulations and rules, there is usually an overwhelming identification that it’s not a felony, but it could be a licensure issue administratively. I have heard the United States Attorney General make the comment on several occasions in several different presidential administrations that when a physician, when a hospital, when a clinic, When a nurse or a dentist or any medical provider can clearly demonstrate that they intend to comply with these issues and laws, they’re not being subjected to a felonious accusation.
Dr. Mark Leeds [25:16] It’s great that doctors wanting to go into these areas of practice, but they can feel comfortable that they’re compliant. There’s one more topic I wanted to cover finally. I believe in the importance of harm reduction. You know, the providing of naloxone, you know, the drug that can reverse an opioid overdose, also known by the brand name Narcan. And there’s also the issue of safe injection sites or safe using sites, which originally was against the idea. But now I believe that probably would be a great thing to have everywhere where a person using drugs and an opioid addicted person or a drug addicted person can go and maybe have their drugs tested for safety, be overseen by an attendant, be given maybe some literature to let them know that help is available. And then also the Narcan, I think, should be everywhere, on every wall where there’s a fire extinguisher.
Bob Coates [26:08] Oh, absolutely. Absolutely. And by the way, that is Sophie Edley, my own private nurse, my puppy dog, that makes me aware that there’s someone outside, and that happens to be mowers in our neighborhood. But I want to address your acute awareness of the value of Narcan. I also consult with Wall Street investors through various and sundry investment intelligence gathering firms. And of recent note, I’ve had several engagements where the whole issue of Narcan and related interventions have been discussed and are of interest in the investment community. The new bill, the H.R. 6 support bill, does address the availability of Narcan. I believe that it is extremely important, and most state legislatures have agreed to allow the public consumption of having Narcan offered to them along. In fact, some states require that the physician actually write a concomitant script for Narcan with prescriptions for Schedule II and Schedule III narcotics. And this is a boon. I think it’s going to drive the price of Narcan down. But I guess more importantly that we look at the issue that is pretty much a hot topic on Capitol Hill right now in Washington as to safe injection sites. This is predominantly currently being proactive on the West Coast. Right now, the Department of Justice, in particular, the Attorney General, has somewhat of a negative view of the safe injection sites, and prosecution has been threatened in some cases. Yet, common sense is prevailing itself, Dr. Leeds. We’re seeing that there is obviously going to be a resurgence of these sites because it clearly, as you indicated, Dr. Leeds, makes sense. It offers observation, and it is by no means condoning the use of illicit drugs or, for that matter, prescription drugs. But there are literally lots of patients when they initially begin to be administered the various long-acting opioids, which are usually Schedule IIs or such as like fentanyl patches, they want an observation for a period of time on initially ingesting or applying the medication. I think it’s wise. I’ve found physicians who have allowed a patient to remain in the clinic for as long as two or three hours just to make sure that their initial introduction to a narcotic, in particular an opioid, is safely administered and is completely understood. I believe as an ancillary idea along with this is that every single physician, Whether or not they are prescribing physician or in some localities dispensing, of course in Florida we no longer have dispensing, there is going to be somewhat of an exception with medication-assisted therapy though. I believe that education, education, education is the key. There are free educational resources through SAMHSA. There’s a plethora of information not only intended for the practitioner to better understand opioids, but also the consumer in language which is easily understandable. And it’s fair-minded. It is cultural fair as well as available in several different languages.
Dr. Mark Leeds [30:13] And that’s an excellent idea. The idea of a safe injection site also being a site to observe people using their or taking their prescribed medication for the first time or just if there’s some concern about a change of medication and it could also be an excellent way to provide observation for induction of medication assisted treatment induction is when a person takes their suboxone or buprenorphine for the very first time and a lot of doctors may not have the time you know or availability when the practices get busy to sit with each and every patient individually. And also when telemedicine becomes more prevalent, the doctors may not even be in the same area. So they have to help the patient remotely with the induction their first time of taking their medication. It’d be excellent to have a place like that.
Bob Coates [30:59] Absolutely, sir. We can expect that there will be legislation. In fact, there is current legislation that is refining the whole medication-assisted therapy protocol and regimen. And I look forward to seeing this being fleshed out. It is a bipartisan effort, which is rarity. I will have to tell you that in all my years of being a lobbyist as well as a clinical practitioner, I have never seen such a strong bipartisan issue. I suppose it was initially the HIV-AIDS epidemic in the early 80s that produced such a bipartisan effort in the United States. Right now, we’re seeing an overwhelming bipartisan effort. There was only one member of the Senate that voted against the H.R. 6 both times initially and then upon the reconciliation. And the reason that senator refused to vote for it is that he felt the whole topic and issue of restricting any form of medical practice was the state’s right issue. It wasn’t that he was against opioid restrictions and training. He just felt like he needed to be addressed by a state jurisdiction. My comment on that is that because there is such an impact to the public trust in terms of the illegality of many of the medications and the definition of overprescribing, which I want to say in our conferences I have always surveyed the attendees as to define overprescribing. It has been my experience that approximately 85% of the attendees cannot define what over-prescribing is.
Dr. Mark Leeds [32:59] Bob Coates, thank you for joining me. I really appreciate it. This is some incredible information, and I know it’s going to help my audience. And I really appreciate you coming on the show today.
Bob Coates [33:08] Well, you’re most welcome, Dr. Leeds. I appreciate your practice. I followed with great interest your efforts and your availability. I would consider that you’re probably two standard deviations in advance of most practitioners in the United States and I congratulate you for that.
Dr. Mark Leeds [33:25] Thank you. Thank you. I appreciate it. Thank you for joining us today on The Rehab on the Mental Health News Radio Network. I hope that you have found this show to be interesting and useful. If so, please subscribe to The Rehab Podcast and share on social media. I appreciate your taking the time to listen to The Rehab. Thank you. Thank you. Thank you. Thank you.
