The staggering news that more than 100,000 people in the U.S. died from drug overdoses between April 2020 and April 2021, the highest number on record, was a stark reminder that the opioid crisis not only persists but has grown worse and more urgent. Many of these deaths, nearly two-thirds of which were caused by opioids, might have been prevented if people struggling with opioid use disorder had greater access to effective treatment. It’s past time for Congress to act and make lifesaving care more available to people in need.
FDA-approved medications — including buprenorphine, methadone and naltrexone — are the gold standard of treatment for opioid use disorder. These drugs help individuals stay in treatment longer, reduce illicit opioid use and infectious disease transmission and decrease overdose deaths.
But these medications are not widely available — often because of regulatory barriers that are the result of stigma and the outdated view that opioid use disorder is a moral failing rather than a medical condition.
For example, federal law requires that all clinicians undergo training and obtain a license before they can prescribe buprenorphine. These restrictions in part contributed to only about 26 percent of people with opioid use disorder receiving any kind of treatment in 2018, and nearly 20 million Americans living in counties where no clinician was authorized to prescribe the drug. This lack of access means that buprenorphine treatment is a privilege that primarily benefits white middle-class patients who, studies have shown, are more likely to receive the medication than Black patients. In addition, areas with a higher percentage of people of color are less likely to have treatment programs that accept Medicaid payment for medication treatment or even provide medications at all.
Furthermore, the training required to obtain a license from the Drug Enforcement Administration to prescribe buprenorphine also triggers a level of oversight — including random inspections of providers’ office records — that also contributes to the dearth of providers who are permitted to prescribe the drug. Eliminating this training and license requirement could lead to more providers viewing addiction as a chronic disease that can and should be treated — while helping to mitigate any fear that buprenorphine is more dangerous to prescribe than other medications. (Buprenorphine has a ceiling effect, meaning that repeated dosing does not increase the drug’s effects.) It will also encourage providers to incorporate opioid use disorder care into their practices and help close treatment gaps among patient populations.
The experience in other countries is informative. For example, clinicians in France were allowed in the mid-1990s to prescribe buprenorphine without additional education or licensing. In just four years, more than two-thirds of people with opioid use disorder received medication, and overdose deaths declined by 79 percent.
Members of both the House of Representatives and the Senate have introduced bipartisan versions of the Mainstreaming Addiction Treatment Act, legislation that would immediately remove training and licensing barriers and help ensure greater access to buprenorphine treatment for people across the country. The growing support among lawmakers — evidenced by the increasing numbers of legislative co-sponsors — is welcome news, given that public health experts consider these obstacles needless requirements that limit the availability of treatment providers. And the requirements apply to no other prescription drug, including the opioid pain relievers that sparked this public health crisis.
Some lawmakers and clinicians have expressed concern that increased prescribing of buprenorphine may lead people with opioid use disorder to obtain the drug indirectly, either from an acquaintance or through illicit purchase — a practice known as diversion. But a recent study shows that buprenorphine misuse among people in treatment for opioid use disorder decreased from 2015 to 2019, despite increases in the availability of buprenorphine. In fact, evidence indicates that the primary reason for buprenorphine diversion is demand from those seeking to manage their opioid use disorder and who are unable to access treatment. And according to the DEA, increasing buprenorphine prescribing may be an effective way to prevent diversion.
The opioid crisis has caused too much suffering and loss across the country, especially among communities of color; it’s hard to find a family that hasn’t been touched by this issue, whether they’ve lost a parent, a child, a friend, or a colleague. And the COVID-19 pandemic — which has brought immeasurable social isolation and financial strain — has only deepened the despair. But the evidence is clear: FDA-approved medications such as buprenorphine are the best way to help prevent opioid overdose deaths and treat opioid use disorder. Our elected officials must remove barriers preventing access to this lifesaving treatment to ensure it is available in an equitable way.
It’s time for Congress to pass the Mainstreaming Addiction Treatment Act. Lives depend on it.
Alaina McBournie is a manager and Jenna Bluestein is a senior associate with The Pew Charitable Trusts’ substance use prevention and treatment initiative.