A unanimous vote in the U.S. Congress last week has eased a significant barrier to treatment for addiction to opiate drugs. In Maine, where the rate of addiction to heroin and prescription drugs such as oxycodone is the fifth-highest in the nation, the change represents an opportunity for hundreds more people to get the treatment they need to live productively.

But some in the substance abuse treatment community say the new law is still too restrictive, leaving thousands of drug-addicted Mainers still waiting to reclaim their lives.

The drug buprenorphine, also known by the trade names Suboxone or Subutex, was approved for use in addiction treatment in this country about 21/2 years ago. Like methadone, it works by satisfying the body’s craving for narcotics without delivering a destructive “high.” With the physiological need met and the assurance of a steady, legal source of the medication, a motivated person who has developed an addiction theoretically can begin rebuilding relationships, finish school, hold a job and generally get on with life.

Though methadone remains the substitute-drug treatment of choice for long-term, deeply entrenched addicts, Suboxone’s reported benefits over methadone are several. It has fewer side effects, it’s less likely to cloud one’s thinking, and it’s less attractive to recreational drug users. It’s also easier to taper and discontinue, while methadone is, for many addicts, a lifelong therapy.

But Suboxone’s greatest advantage is its convenience. While methadone users must check in each day at a heavily regulated clinic to receive their daily dose, Suboxone can be prescribed for a month at a time by any physician who has taken an eight-hour certification course.

The main sticking point with Suboxone has been a controversial restriction on its use. Its approval in 2002 by the federal Food and Drug Administration was tempered by a legislated limit of 30 patients per physician practice, regardless of the size of the group. A rural clinic in Washington County with four doctors could treat 30 patients with Suboxone, and a major urban medical center with hundreds of doctors also could treat 30 patients.

The intent of the cap is to prevent physician practices from being overrun with drug-addicted patients, both to ensure that patients with the relatively new medication get the careful assessment they need and to prevent community clinics from turning into de facto addiction centers.

This week’s congressional vote expanded that limit to allow each certified physician in a practice to prescribe the drug for 30 patients.

According to Kim Johnson, director of Maine’s Office of Substance Abuse, the expanded access to Suboxone treatment is a welcome change. “Those of us who live in states without a lot of treatment options have been crying for this,” she said Thursday. “The buprenorphine experiment has gone well, and this opens it up for more people to get the treatment they need.”

Johnson said there are now 108 physicians in Maine who are certified to treat with Suboxone. Not all of them have chosen to open their practices to patients with drug addictions, she said, but those who have done so are at their 30-patient limit and have waiting lists. In the past year, she said, Maine physicians issued Suboxone prescriptions to about 2,080 individuals.

At the Mercy Recovery Center in Westbrook, medical director Dr. Mark Publicker said the expanded patient limit would have little effect on his practice. Because he has just one physician partner, they’ll be able to treat 60 clients instead of 30 with Suboxone.

“But there are thousands of people in Maine who need this drug,” he said. Publicker, who before coming to Maine served as the head of addiction medicine at Kaiser Permanente in Washington, D.C., said last week that federal officials and lawmakers are being overcautious and should do away with the cap altogether, at least for physicians who specialize in addiction treatment.

“Imagine, a drug that’s as lifesaving as this one is,” he said. “If this were a cancer medication, people would be marching in the streets [to get rid of the cap]. But because this disease affects an unpopular, stigmatized population, the cap doesn’t get challenged.”

Publicker, who serves on a special physician support network with the federal Substance Abuse and Mental Health Services Administration, said about 7,000 physicians nationwide are certified to prescribe Suboxone, but only about 2,000 routinely prescribe it as part of their practice. Lifting the per-practice cap will help, he said, but other barriers remain. For example, many doctors feel that addiction treatment is a medical specialty they’re unprepared to practice, and others feel they can’t afford to open their doors to a large volume of low-income patients whose medical bills are paid by Medicaid.

Even though Maine lawmakers recently voted a 15 percent increase in Medicaid physician fees, Publicker said many doctors in private practice remain reluctant. And, since Maine’s Medicaid program, called MaineCare, recently restricted the enrollment of young adults without children, much of the substance-abusing population is no longer eligible for medical or mental health services of any kind.

Kim Johnson at the state’s substance abuse office said even without MaineCare or other coverage, people seeking access to Suboxone or other addiction therapy should contact a health care provider. “There are multiple ways to access treatment, and providers should be able to work with them to get them the help they need,” she said.

A list of Maine physicians certified to prescribe Suboxone is available online at: http://buprenorphine.samhsa.gov or by calling the Maine Office of Substance Abuse at (800) 499-0027.