Should we loosen restrictions on one of the supposedly-best ways to treat opioid addiction, or would it actually just make the problem worse?
The opioid crisis caused more than 68,500 deaths last year. That exceeds the peak year of deaths for AIDS, car crashes, or gun violence. The good news, if any, is that opioid deaths dropped by about -5% in 2018 from the peak in 2017.
One of the most effective ways to treat opioid addiction is through a medication called buprenorphine. However, the Drug Addiction Treatment Act of 2000, passed as part of the Children’s Health Act of 2000 — well before the 2010s opioid crisis — often stands in the way.
The law requires physicians and doctors to obtain a waiver from the Drug Enforcement Administration (DEA) through an often-burdensome processbefore they can prescribe buprenorphine for addiction. This even though physicians can prescribe buprenorphine for pain relief _without _this waiver.
France, which used to require a similar waiver, dropped the requirement in 1995 and opioid deaths subsequently plummeted.
What the legislation does
The Mainstreaming Addiction Treatment Act is a bipartisan bill that would allow doctors and physicians to prescribe buprenorphine for addiction without the DEA waiver, as is currently allowed for pain relief.
The House version was introduced on May 2 as bill number H.R. 2482, by Rep. Paul Tonko (D-NY20). The Senate version was introduced more than two months later on July 10 as bill number S. 2074, by Sen. Maggie Hassan (D-NH).
What supporters say
Supporters argue the bill would allow medical professionals a critical tool, for which they currently have to jump through hoops — if they get approved for the waiver at all.
“America’s opioid epidemic has ravaged countless American families and shocked the conscience of our nation,” Rep. Tonko said in a press release. “Despite a heartbreaking death toll that has set new records in each of the last two years, we are not powerless in the face of this crisis.”
“For nearly two decades, buprenorphine has provided the cornerstone for safe, effective and life-saving treatment for Americans with a diagnosed substance use disorder,” Rep. Tonko continued. “We need to unbind the hands of our medical professionals on the front lines of this epidemic and make this proven, safe addiction treatment available to every American working to overcome addiction and find or follow the path of recovery. And we need to do it now.”
“Medication-assisted treatment is the gold standard for treating substance use disorder, and we need to break down the barriers that prevent more health care providers from treating patients in need,” Sen. Hassan said in a separate press release. “This commonsense, bipartisan measure [would] expand access to buprenorphine and help more people get on the road to recovery.”
What opponents say
Opponents counter that the bill would actually make the problem worse, because it would be putting more power and fewer regulations on the doctors who arguably started the opioid crisis through overprescription.
“Wanting the same clinicians that have caused the excessive use of opiates to now be able to prescribe buprenorphine without the training verification required by the waivers is ridiculous,” said Charles A. Reynolds, PharmD, BCPP Reynolds Consultants.
“It is without a doubt a mistake to allow HR 2842 to proceed as written. Removing the waiver requirement will not address the opiate abuse issue it states as its purpose. It will open the door to to illegitimate use of the drug and worsening of the problem,” Reynolds continued. “What is needed is more clinicians to be properly educated in opiate use disorder so that they too can get certified to use Buprenorphine. The bill should be changed to fund this need.”
Odds of passage
The House version has attracted 78 bipartisan cosponsors: 62 Democrats and 16 Republicans. It awaits a potential vote in either the House Energy and Commerce, Judiciary, or Ways and Means Committees.
The Senate version — in addition to its Democratic lead sponsor — has attracted two cosponsors, both Republicans. The far fewer cosponsors than the House version, as a percentage of the chamber’s size, is likely due to its having been out for several months less. It awaits a potential vote in the Senate Health, Education, Labor, and Pensions Committee.
This legislation does seem potentially likely to pass, given its bipartisan cosponsorship in the House and the geographically dispersed extent of the opioid crisis. In these polarized times, one of the few pieces of legislation to pass with bipartisanship was last October’s SUPPORT for Patients and Communities Act to tackle the opioid crisis.