Contrary to his campaign promises, President Joe Biden has made it harder for health care providers to provide treatment for opioid addiction.
In January, the Trump administration announced a policy to reduce restrictive licensing of buprenorphine, widely considered an effective treatment for opioid addiction, reducing opioid use, infectious disease transmission, and criminal behavior, as well as improving outcomes for long-term treatment and employment.
Weeks after taking office, Biden reversed the policy. Providers will now have to obtain an “X-waiver” to prescribe the drug for opioid addiction treatment. Currently, less than 10 percent of physicians nationwide can prescribe the drug, with rural counties at a distinct disadvantage.
In the 12 months ending in June 2020, 83,000 people died of a drug overdose in the United States, the highest number of overdose deaths in a 12 month period, according to the U.S. Centers for Disease Control and Prevention.
“I can’t think of a single good reason why the Biden Administration, which purports to be concerned about addiction and overdoses, rescinded the order,” said Jeffrey Singer, M.D, a senior fellow at the Cato Institute. “In fact, I was hoping they would have expanded on the order to allow it to apply to nurse practitioners and physician assistants and to remove its limits on the number of patients who may be treated with buprenorphine at any given time.”
As of March 5, Biden has yet to publish a full explanation for reversing the rule.
Outdated Restrictions
Approved by the FDA in 2002 to treat opioid addiction, buprenorphine continues to be a leading treatment option for clinicians, but the treatment entailed dispensing restrictions. A physician must have completed an 8-hour course and comply with multiple other patient limits to treat opioid addiction with buprenorphine, though it can be prescribed to treat pain without these limitations.
“Since the early part of this century, it has been found effective as a medication-assisted treatment for opioid use disorder,” Singer said. “The buprenorphine binds with opioid receptors to block the attachment of stronger opioids, like morphine or heroin. In people who are tolerant to much stronger opioids, like oxycodone, morphine, or heroin, this mild opioid doesn’t give them euphoria and is less likely to suppress the respiration rate. It is combined with the opioid antidote naloxone into a single drug, known as ‘suboxone.’ The naloxone cancels out the effect of the opioid if people try to inject it, but doesn’t get absorbed when people take it orally, as directed.”
An Opioid Epidemic
In the last 20 years, nearly 500,000 Americans have overdosed on opioids, now considered the number one cause of accidental death. As lockdowns, financial and employment instability have spread, so has opioid misuse, hitting an all-time high in 2020.
Trump’s policy had relaxed physician usage by allowing Drug Enforcement Administration-prescriber licensed physicians to treat 30 patients in-state, removing the cap for doctors working in a hospital setting, and keeping in place the 275-patient cap for physicians receiving the waiver.
“Buprenorphine is widely recognized by the medical community as an effective treatment for addiction,” Singer said. “Recent research shows suboxone and methadone are the only approaches to opioid use disorder that are associated with reduced overdoses and other opioid-related morbidities. There has been widespread support for removing the DEA’s X-waiver requirement from practitioners wishing to treat addiction. Only about 7 percent of providers have jumped through the hoops required for an X-waiver.”
In its last session, Congress attempted to deregulate the drug in a bipartisan effort.
“I thought when the Trump administration, in its closing weeks, relaxed the X-waiver requirement, at least for physicians, it was a great step in the right direction,” Singer said.
Ashley Bateman (bateman.ae@googlemail.com) writes from Alexandria, Virginia.