Trump Administration Will Let More Doctors Prescribe Drug To Fight Opioid Addiction

Jan 15, 2021
Originally published on January 15, 2021 1:46 pm

The Trump administration introduced new addiction treatment guidelines Thursday that give physicians more flexibility to prescribe a drug to patients struggling with opioid addiction.

The Department of Health and Human Services is eliminating the requirement that physicians obtain a special federal waiver in order to prescribe buprenorphine, a medication to treat opioid use disorder. Previously, doctors had to take an eight-hour course to receive the license, called the "X-waiver."

The obstacle discouraged doctors from pursing buprenorphine as an addiction treatment for patients, despite evidence it was highly effective in preventing a relapse, advocates for the change have long said.

"The medical evidence is clear: access to medication-assisted treatment, including buprenorphine that can be prescribed in office-based settings, is the gold standard for treating individuals suffering from opioid use disorder," said Adm. Brett P. Giroir, assistant secretary for HHS, said in a statement. "Removing some of the certification requirements for an X-waiver for physicians is a step toward providing more people struggling with this chronic disease access to medication assisted treatment."

The administration's move comes at a time when the U.S. is again facing record levels of drug overdose deaths, according to the Centers for Disease Control and Prevention.

More than 83,000 people died of drug overdoses in the U.S. in the 12 months ending in June 2020, the CDC said. It's the highest number ever recorded in a one-year period, and a more than 21% increase compared to the previous year. While the category include all drug overdose deaths, the CDC says the increase is largely driven by synthetic opioids.

The American College of Emergency Physicians, the national medical society representing emergency medicine, applauded HHS's new guidance.

"As emergency physicians, we see every day the devastating effects that the opioid crisis has had on the communities we serve—a crisis that has unfortunately only worsened during the COVID-19 pandemic," Mark Rosenberg, president of ACEP, said in a statement Thursday. "Buprenorphine is the most important medication in our arsenal for treating opioid use disorder, which is currently one of the most lethal diseases for Americans."

The American Medical Association also praised the move, saying it will allow earlier intervention by doctors treating patients suffering addiction.

"With this change, office-based physicians and physician-led teams working with patients to manage their other medical conditions can also treat them for their opioid use disorder," Dr. Patrice Harris, who heads the AMA's opioid task force, said in a statement.

Harris also said allowing doctors to treat opioid addiction as they treat other medical conditions, without additional regulatory hurdles, will reduce the stigma that has often shaped the healthcare response to substance use disorders.

Under these new guidelines, doctors who possess a Drug Enforcement Administration registration will still be limited to treating no more than 30 in-state patients with buprenorphine for addiction treatment at any one time. Nurse practitioners or physician assistants will still need to apply for separate waivers to prescribe buprenorphine.

The guidelines are not considered a new law or federal regulation, making it very easy for the President-elect Joe Biden administration to walk back this policy if so desired.

Giroir told Stat News that he thinks that scenario is unlikely, saying, "I doubt it seriously."

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MARY LOUISE KELLY, HOST:

The Trump administration has made it easier for people suffering opioid addiction to get a life-saving medical treatment from their regular doctor. A new rule makes it simpler for doctors to prescribe a drug called buprenorphine. This comes as opioid overdose deaths continue to rise. NPR addiction correspondent Brian Mann reports.

BRIAN MANN, BYLINE: When Sara Combs found a residential treatment program for her son, Adam, who was addicted to prescription pain pills and the deadly synthetic opioid fentanyl, she thought he was on track and would get healthy again.

SARA COMBS: They called me, like, on a Wednesday, and they said he's getting out tomorrow.

MANN: Combs is a nurse who lives in Phoenix, Ariz. She says Adam came home without any medication, nothing to help him avoid cravings or relapse. A few days later, she found him in her guestroom.

COMBS: I went in and touched him, and he was cold. And I see on the ground, like over his bed, I see the foil and the straw because that's how he was, you know, smoking that Percocet 30. So I was just - what do you mean you're dead, you know?

MANN: Adam, who died in 2018, was 26 years old, part of a devastating wave of opioid overdoses that has surged again by 20% during the COVID pandemic. Now the Trump administration has responded by making it far easier for doctors to prescribe buprenorphine, a drug that sharply reduces withdrawal symptoms and opioid cravings. Federal officials dropped a longstanding requirement that doctors treating opioid addiction get extra training and a waiver before prescribing buprenorphine. Admiral Brett Giroir is assistant secretary in the Health and Human Services Department.

BRETT GIROIR: This change is earthshaking to the substance use community, and I do believe it will save thousands or tens of thousands of lives.

MANN: This comes as part of a broader effort to destigmatize medical treatment for Americans caught up in the opioid epidemic. Keith Humphreys, who studies addiction treatment at Stanford University, says it was long overdue.

KEITH HUMPHREYS: You didn't need any extra training to prescribe buprenorphine for pain, nor did you need any extra training to prescribe OxyContin. So if you can do those things, it really made no sense that you couldn't prescribe buprenorphine for addiction.

MANN: Dr. Patrice Harris, who heads the American Medical Association's Opioid Task Force, says she thinks this will help more doctors view addiction as something they can treat.

PATRICE HARRIS: Yes, office-based physicians will see this as an elimination of a barrier and will add this to their practices.

MANN: Sara Combs, who lost her son Adam to opioids, says she wishes the reform had come earlier. She believes buprenorphine might have kept him alive.

COMBS: All he could think of was his cravings and needed to go back to it right away. And I think that's why he so quickly passed.

MANN: This change comes in the final days of the Trump administration. Experts say the incoming Biden team is expected to leave the policy in place. Brian Mann, NPR News.

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