The strain of the COVID-19 pandemic has intensified the opioid epidemic. New numbers from the Centers for Disease Control and Prevention (CDC) show drug overdoses rose to new heights in the first year of the pandemic, as people lost jobs in the lockdowns and watched loved ones succumb to the virus.
In his first address to Congress on April 28, President Joe Biden can send a signal of hope to the hundreds of thousands of American families who are suffering the ravages of the opioid epidemic, and he should announce that he will expand access to a proven, life-saving medication: buprenorphine.
For more than 20 years, physicians and other qualified primary care practitioners who prescribe this medicine for opioid use disorder have been subject to special restrictions, including a requirement to evaluate patients in person before treatment can begin, special training and licensure, and oversight from the Drug Enforcement Administration (DEA). These restrictions were rooted in stigma. In the past, substance use disorder was often viewed as a moral failing, and medication treatment as simply exchanging one drug for another.
But evidence since has shown that substance use disorder is a chronic disease, and that when buprenorphine is used to treat opioid addiction, it does not deliver a “high.” Instead, years of clinical testing have shown that buprenorphine helps patients ease their cravings and begin recovery, and it was approved as a safe and effective medication by the Food and Drug Administration (FDA) in 2002.
The new CDC preliminary figures are alarming: More than 87,000 Americans died of drug overdoses from October 2019 to September 2020, by far the most recorded in a single 12-month period, with a sharp increase in the early months of quarantine. People with substance use disorders were more isolated than ever, medical resources were stretched and seeking in-person treatment could expose them to the virus. In response, the rule requiring patients to be seen in person before they could begin taking buprenorphine was temporarily waived, so prescribers could evaluate patients safely via phone or video sessions and patients could begin treatment more quickly during the pandemic.
Preliminary reports suggest that the waiver was helpful. But it will lapse when the pandemic emergency is declared over — unless Biden decides that he can and will make the waiver permanent.
A new study from George Washington University, funded by The Pew Charitable Trusts and where I work, lays out the regulatory steps the administration can take to provide patients access to telemedicine, and allow them to begin treatment whether they’re miles from their provider in a remote rural area or just around the corner. The study describes three approaches:
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The DEA and the Substance Abuse and Mental Health Services Administration (SAMHSA) could issue joint regulations allowing practitioners to prescribe the medication without first conducting an in-person medical evaluation.
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DEA and SAMHSA could establish a special registration program for providers to participate in telemedicine.
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After the COVID-19 emergency declaration is lifted, both agencies could extend flexibilities under the existing opioid epidemic emergency declaration, which was declared in 2017 and predates the COVID-19 pandemic. Such a move would hold, however, only as long as the opioid declaration remains in force.
Any of these approaches would help, and the administration is considering new rules. In fact, just today the Biden administration announced new federal guidance that will allow physicians, nurse practitioners, physician assistants and other qualified health care providers to treat 30 or fewer patients with buprenorphine for opioid addiction. But there’s still more Biden can do.
He can use his speech to ask members of Congress to remove the outdated federal law requiring medical providers to undergo special training and licensure before they can prescribe buprenorphine. Public health experts consider this a needless rule that limits the availability of treatment providers. And it’s a requirement that applies to no other prescription drug, including the opioid painkillers that accelerated the overdose crisis.
The best way to remove this outdated requirement is through congressional action; Congress made the law and Congress can change it. The Mainstreaming Addiction Treatment Act would eliminate the special training and license needed to prescribe buprenorphine. The bill, first introduced in 2019, would also do away with restrictions on the number of patients that providers may treat concurrently. Biden can make the bill’s passage a priority for his administration and work with bipartisan congressional champions to pass it.
On the campaign trail, then-candidate Biden spoke movingly of his own family’s personal experience with the struggles of substance misuse, providing insight, inspiration, and hope to others. Now, as president, he can use the focus of his first address to Congress to take direct action, ease access to treatment, and save lives.
Beth Connolly is the director of The Pew Charitable Trusts’ substance use prevention and treatment initiative.