What is the DATA 2000?
If you’re looking for information on the DATA 2000, you or someone you know is probably considering opioid maintenance therapy (OMT.) Since opioid maintenance therapy was quite controversial during its early stages, it was necessary for physicians wishing to provide this type of treatment to get additional certification.
The DATA 2000, or the Drug Addiction Treatment Act of 2000, was the legislation that allowed opioid medication to be widely prescribed for the treatment of illegal drug addiction. There are still many questions that are raised in regards to this type of treatment, and not all of them have answers that will please everyone. Still, the DATA 2000 has allowed many people access to treatment that they couldn’t receive before.
What instigated the DATA 2000?
The main cause leading to the creation of the DATA 2000 was the discovery of buprenorphine. Buprenorphine is a highly effective medication for people who are struggling with an addiction to illegal narcotics, and it has helped countless people regain some stability in their lives. But why do we need buprenorphine - hasn’t methadone been helping opioid addicts for years?
The answer to that question, and much of the reason that the DATA 2000 was created, is because methadone isn’t always the best solution for opioid addicts. While methadone does provide relief for many thousands of people, it can cause a number of distinct problems that buprenorphine will not.
- The chance of overdosing on methadone is much more significant than the chance of overdosing on buprenorphine. This is because of the way the two drugs work. Both methadone and buprenorphine are known as opioid agonists. An opioid agonist is a drug that gives the user the traditional ‘morphine-like’ feeling. They do this by agonizing, or activating, the brain and body’s opioid receptors.
- Too much stimulation of the brain’s opioid receptors can result in overdose for a number of reasons, particularly hypoventilation and coma.
- The reason buprenorphine carries a lower risk of overdose is because buprenorphine is a partial agonist with a higher binding affinity. A drug’s binding affinity is the degree to which it will adhere to a receptor.
- We mentioned that methadone is an opioid agonist, but so is buprenorphine. Why the difference? Buprenorphine, a partial agonist, is able to fully occupy the receptor sites without fully activating them. This allows the buprenorphine to saturate the receptors without providing the full narcotic effect of other full agonists, like methadone or morphine.
- Methadone has also been indicated as a cause of serious dental problems. Many opioids are known for causing dry mouth, but methadone does so to a more significant degree. Dry mouth, if not treated, can result in the decaying of tooth enamel and gingivitis.
If methadone was already an option, why did we need DATA 2000?
There are several reasons that DATA 2000 was needed.
Methadone clinics (clinics staffed with physicians specialized in treating opioid addictions) have been allowed to prescribe methadone for many years. This is because methadone has been legal in the USA since 1947 as a schedule II drug. It has been used for the treatment of chronic pain as well as opioid addiction. However, since methadone is a schedule II drug, practitioners must meet quite a few qualifications to be able to prescribe it.
- They must hold a state medical license
- They must be licensed by the state as a methadone provider.
- The physician or medical practitioner's establishment must be accredited by one of the following establishments
- The Commission on Accreditation of Rehabilitation Facilities (CARF)
- The Council on Accreditation (COA)
- The Joint Commission (TJC).
- The physicians must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) for their facility to constitute an opioid treatment program.
- They must complete registration with the Drug Enforcement Administration (DEA).
That’s quite a lot of legal hoops for a practitioner to jump through. However, buprenorphine is a bit different, since it’s a schedule III narcotic. Schedule II drugs are more tightly monitored than schedule III, IV, or V.
The DATA allows for physicians to apply for a waiver that will allow them to prescribe buprenorphine to patients. To apply for this waiver, the physician need only meet the following qualifications.
- They must hold a state medical license (which all physicians should)
- They must be registered with the D.E.A.
- They must hold a certificate from the American Society of Addiction Medicine
- They must meet one of the criteria that can be found at this website.
In writing, that may seem like a similar amount of work, but it’s much easier for a doctor to get a waiver so they can prescribe buprenorphine than it would be for them to prescribe methadone, since doing so involves registering their entire facility as a methadone clinic.
So what has the DATA2000 done?
Since the DATA2000 was signed, buprenorphine has been prescribed far more often for opioid maintenance therapy. Since buprenorphine has a less dangerous profile of effects and is much less likely to cause overdoses, it has saved many lives.
Consider these statistics. In 2009, 30% of all deaths related to painkillers were attributed to methadone. In fact, methadone was the cause of 40% of deaths caused by a single painkiller.
Suboxone is not free from problems, but the numbers suggest it’s a much safer alternative. A six year study done in the UK counted over 2,300 deaths caused by methadone. In the same timespan, there were only 52 deaths caused by buprenorphine.
The DATA2000 also allows practitioners to prescribe buprenorphine in many different areas - hospitals, prisons, private offices. They do not need to explicitly label their establishment as a buprenorphine clinic, thanks to the DATA2000.
The DATA2000 may have been controversial when it was first written, but it has since changed the lives of many people struggling with addiction. The DATA2000 allows for a much wider distribution of medication for opioid maintenance treatment. The medications that the DATA2000 allows practitioners to prescribe are considered much safer than the popular alternative, methadone.
The DATA2000 has changed the face of the addiction medicine industry and have saved many lives. While there are dangers associated with the abuse of any drug, the DATA2000 has made safer drugs much more readily available.