More than 107,000 people in the United States died from a drug overdose in 2021 — the highest annual number ever recorded — and the crisis has not abated. Opioid-related overdoses accounted for 75 percent of these deaths, many of which might have been prevented if more people could access lifesaving addiction treatment.
But that situation can change if Congress steps up and passes the bipartisan Mainstreaming Addiction Treatment (MAT) Act when it returns for its December session. This legislation will help more people gain access to buprenorphine, a Food and Drug Administration-approved medication to treat opioid use disorder (OUD).
Simply put, buprenorphine and other medications for OUD — including methadone and naltrexone — save lives. They are the most effective therapies for the condition and are proven to reduce overdose deaths, slow infectious disease transmission, curb illicit drug use, and help people stay in treatment longer. They also make it possible for people with OUD to manage a chronic condition while staying employed and caring for their families. But antiquated regulations and pervasive social stigma around addiction keep these therapies out of reach for most people who need them. Data from 2020, the most recent year available, show that only 11 percent of people with OUD received one of the three FDA-approved drugs.
Regulations governing buprenorphine are particularly burdensome. Under current federal laws, health care professionals are required to participate in additional training approved by the Substance Abuse and Mental Health Services Administration (SAMHSA) and obtain a waiver from the U.S. Drug Enforcement Administration (DEA) to prescribe buprenorphine for OUD to more than 30 patients. No other prescription medication in the United States is subject to these onerous requirements. Even after receiving a waiver, the number of patients a health care provider can treat for OUD is capped. And the provider may face additional scrutiny from the DEA, including random office inspections.
So, it is not surprising that these burdens leave only a small percentage of health care professionals willing and able to prescribe buprenorphine, resulting in large swaths of the U.S. without a licensed provider. In 2018, nearly 40 percent of U.S. counties had no authorized providers able to prescribe the drug. And in rural communities, it’s particularly difficult to access. In 2017, buprenorphine was out of reach for almost 30 percent of rural residents, compared to about 2 percent of urban Americans.
These barriers hit communities of color the hardest. Research shows that white, middle-class patients are more likely to receive buprenorphine than Black patients. And communities of color are less likely to have access to a treatment program that accepts Medicaid insurance or offers medications for OUD. All of these barriers have been exacerbated during the COVID-19 pandemic.
Elected officials have the chance to eliminate barriers to medication treatment for people with OUD. The MAT Act has passed in the House of Representatives with overwhelming bipartisan support and has growing support in the Senate. The legislation would remove the training and licensure requirements that health care professionals face and immediately allow any DEA-licensed provider to prescribe buprenorphine for patients with OUD.
Removing these regulatory barriers would also help dispel the myth that buprenorphine requires special education and training because it’s more dangerous or difficult to prescribe than other medications. And it would support the fact that OUD is a chronic condition that can be treated in typical health care settings. This, in turn, may encourage health care providers who have been reluctant to treat patients with OUD to begin incorporating addiction care into their practices, which goes a long way toward closing treatment gaps throughout the country and reducing stigma.
Some lawmakers fear that making buprenorphine easier to prescribe will lead to diversion — when people obtain the drug indirectly from an acquaintance or illicit purchase. That’s not the case. Research shows that buprenorphine diversion often occurs when people try to manage their OUD but don’t have access to treatment. Furthermore, according to the DEA, increasing buprenorphine prescribing could actually prevent diversion.
Federal lawmakers have long spoken about the urgent need to curb the opioid crisis, citing the tragic toll that overdose deaths have taken on families and communities throughout the country. There is no better way to stop these needless deaths than to increase access to lifesaving medications such as buprenorphine. The MAT Act will do just that. And it is one of those rare pieces of legislation that is both bipartisan and supported by research, science, and common sense.
The House has passed its version of the bill. Now the Senate needs to do its part before the session ends. Lives are at stake.
Sheri Doyle is a senior manager and Vanessa Baaklini is a senior associate with The Pew Charitable Trusts’ substance use prevention and treatment initiative.