Adam Knott, Brianna Diaz and Emily Thorn: Let’s ease restrictions on drug that treats opioid abuse

Among a staggering 70,237 accidental overdose deaths in the United States in 2017, over two-thirds involved opioids. An estimated 2.1 million people currently suffer from opioid use disorder nationwide. In Spokane County, rates of opioid overdose rank higher than the statewide average.

Two decades into this crisis, the situation is dire, but far from hopeless. There are multiple highly effective therapies available to reverse opioid overdose and treat addiction. Overdose deaths are preventable. Our challenge now is to increase access to these lifesaving medications.

Buprenorphine, known by the trade names Suboxone and Subutex, is a clear target for action. It is one of three FDA-approved medications to treat opioid use disorder and has dramatically lower potential for abuse and overdose compared to other opioids. Buprenorphine alone significantly reduces rates of relapse and overdose. This can likewise lower rates of infectious disease transmission, medical complications, hospitalizations and recidivism, benefiting the community at large.

Despite this, access to buprenorphine is currently restricted in a way other medications are not. The Drug Addiction Treatment Act of 2000 (DATA 2000) extended buprenorphine treatment for opioid use disorder to the primary care setting, but requires providers to undergo special training and apply for an “X Waiver” before prescribing.

While earnest in its attempt to address the rapidly growing crisis, DATA 2000 has unnecessarily restricted access to buprenorphine. Health care providers often lack the time and support to complete training requirements. As a result, less than 8% of physicians are waivered, hitting low resource and rural communities hardest.

Fewer prescribers also means greater gaps in coverage. Patients who are successfully stabilized on buprenorphine during hospitalization struggle to refill this medication after discharge. Individuals who are incarcerated often abruptly lose access to coverage. Waivered providers likewise face barriers when prescribing. The number of patients each provider may treat is capped and subject to stringent monitoring requirements. Without waivered colleagues, providers may not be able to guarantee coverage to patients when off shift.

It is important to ensure providers are educated about best prescribing practices, but this holds true for any FDA-approved medication, many with safety risks far greater than buprenorphine. A waiver is not required for these medications, including the opioids that helped fuel the overdose crisis. Even in the case of buprenorphine itself, a waiver is not required when prescribing for conditions other than opioid use disorder, such as pain. As with other pharmacotherapies, provider training is best achieved when integrated into medical education and continuing education courses. The vast majority of U.S. LCME-accredited medical schools have already structured this into their curricula.

When France removed similar regulations, access to buprenorphine increased and overdose deaths dropped by 79% over the following three years. If the U.S. saw even a 50% decline, tens of thousands of lives would be saved, many of whom would likely go on to achieve recovery. This is further bolstered by U.S.-based studies that show prescribing buprenorphine in the emergency department is effective at increasing the number of patients seeking treatment.

National efforts to eliminate the X Waiver are underway. Public health officials of over 20 U.S. states and territories, including Washington state, and the Washington State Medical Association have called for elimination of the X Waiver. Supported by the American Medical Association, American Society of Addiction Medicine, Medical Student Harm Reduction Alliance, and over 100 bipartisan co-sponsors, the Mainstreaming Addiction Treatment Act (H.R. 2482), along with S. 2074, amends the Controlled Substances Act and DATA 2000 to remove registration requirements for Schedule III-V addiction treatments such as buprenorphine.

Despite widespread support, only three representatives from the state of Washington have co-sponsored this legislation. The support of our representatives is necessary to ensure this legislation remains a priority. Consider reaching out to your representatives today at 202-224-3121. Call for co-sponsorship of H.R. 2482 and S. 2074.