One of the ongoing frustrations in the response to the devastating opioid crisis has been the inability to get the most effective forms of treatment to the hundreds of thousands of Americans who need them. Despite gains in some corners, significant barriers remain for people seeking medication-assisted treatment, the most proven way to treat opioid use disorder.
There are a number of reasons why, but perhaps the easiest to fix is the federal requirement that medical providers acquire a special waiver — requiring additional training, registration and oversight — to prescribe buprenorphine, adding unnecessary time and effort to the process of treating patients.
That’s a big part of the reason only about 5 percent of medical providers can prescribe the medicine nationwide. In Maine in 2017, when an estimated 25,000-30,000 residents needed treatment and about one Mainer a day was dying from overdose, only about 230 of the state’s 2,000 primary care physicians held the waiver.
The Mainstreaming Addiction Treatment Act, now before the U.S. House and Senate, would end the waiver requirement, allowing more primary care physicians to take on patients dealing with opioid addiction, filling a critical need throughout the country. Congress should pass it.
Buprenorphine, often prescribed as Suboxone, should be in the hands of every person who needs it. It alleviates the symptoms of opioid withdrawal, giving patients a chance to live their life free from the pain and control of addiction. It has been shown to keep people in treatment longer, and reduce mortality up to 50 percent. It makes patients less likely to use illicit opioids and contract infectious diseases.
According to the National Academies of Sciences, there are no reasons to limit its prescription. Though buprenorphine is often combined with counseling in treatment, it remains very effective without it. Concerns over misuse are overstated.
Every day, doctors prescribe medications more powerful and dangerous than buprenorphine — insulin, acetaminophen, even opioids themselves — without extra training or oversight. They regularly treat chronic conditions just as complex as addiction without a federal waiver.
It’s important that more doctors have the ability to prescribe medication-assisted treatment. The doctor’s office is often the best venue; it’s where many patients are comfortable, and where their health can be considered holistically.
What’s more, patients may not be able to find medication-assisted treatment elsewhere. According to Vox, less than half of addiction recovery facilities included in federal data provide either buprenorphine, methadone or naltrexone, the most proven treatments. Barely any offer all three.
Even with the waiver requirement, Maine has made great strides in licensing providers for buprenorphine. Gordon Smith, director of opioid response for Gov. Janet Mills, told the Editorial Board there are now 1,420 providers with waivers in Maine, double a year ago.
But those with waivers aren’t necessarily treating patients, and Maine needs more providers to fill its considerable need for treatment. Eliminating the waiver will help, as it will help other states that have not been as successful as Maine in recruiting providers.
To beat the nationwide opioid crisis, people need access to the right kind of medication-assisted treatment where it serves them best. When that means buprenorphine through a doctor’s office, eliminating the federal waiver requirement will help make it more widely available.
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