Innovations-Magazine-October-2022 - 4

POLICY PERSPECTIVES
Medication Treatment for Opioid Use Disorder:
Where Do We Go From Here?
Megan S. Herber, MPH
Faegre Drinker Biddle &
Reath LLP
Nisha K. Quasba, MPH
Faegre Drinker Biddle &
Reath LLP
The opioid epidemic is not new, but despite
provider, policymaker, and other stakeholder
efforts over the years, it has not gone away.
Drug overdose deaths reached an all-time
high in the United States in 2021, with
fatalities up 15% in 2021 compared to
2020 - when the US had already seen a
30% jump in such deaths as the spread of
the coronavirus disease 2019 (COVID-19)
disturbed medication treatment for substance
use disorders (SUDs) and isolated many.
The two-year double-digit percent increases
signal a growing problem with drug misuse
that threatens to create more grim milestones
for Americans. With mental illness on
the rise and SUD impacting about half of
American households, Congress has taken
an active interest in addressing both issues.
One of the most effective forms of
therapy for opioid use disorder (OUD)
to help individuals sustain long-term
recovery is medication treatment: the
use of Food and Drug Administrationapproved
medications (buprenorphine,
methadone, or naltrexone) in combination
with counseling and behavioral therapies.
However, due in large part to stigma
around addiction care, policy and culture
have limited access to this important
treatment, and policymakers have only
made incremental advances to remedy this.
Due to fears of diversion and abuse, policy
around access to addiction treatment has
traditionally been coupled with safeguards -
limits on the number of patients a
provider can treat, additional trainings
for practitioners, and requirements that a
provider must see a patient in person or
2 | OCTOBER 2022
in a certain setting. Though maybe wellintentioned,
these extra layers of protection
have created barriers to care. But when the
pandemic brought the country to a standstill
and the health care system scrambled
to maintain patient care, policymakers
temporarily waived many of the safeguards
in place and took a closer look at outdated
policies that needed to catch up with the
current health care delivery ecosystem.
An Extra Layer of
Federal Bureaucracy for
Addiction Treatment
As detailed in the November/December
2020 issue of Innovations, immediate past
NABP Chairperson Timothy D. Fensky,
RPh, DPh, FACA, made updating policy
on the pharmacist's role in medication
treatment for OUD his top priority. The
main target? Repealing the outdated federal
waiver process that providers must undergo
in order to prescribe buprenorphine.
Methadone was the first available
medication treatment for OUD, but
due to its potential for abuse, it has been
" Certain certification and
training requirements
needed to prescribe
buprenorphine were
exempted during the
COVID-19 pandemic to
help expand access to
treatment, especially
after the startling drug
overdose death statistics
of 2020 were released. "
highly regulated and only allowed to be
offered in certain settings where a patient
is under medical care. Buprenorphine, a
Schedule III drug, has less potential for
abuse but is closely regulated by Drug
Enforcement Administration (DEA).
Over 20 years ago, Congress passed
the Drug Addiction Treatment Act of
2000 (DATA 2000), which required
practitioners to obtain a waiver from
the Substance Abuse and Mental Health
Services Administration to practice opioid
dependency treatment with approved
buprenorphine medication and additional
training, registration, and oversight.
This was seen as expanding access to care
because the requirements are less stringent
than those for methadone. However, in
comparison to requirements on providers
for any other medical treatment, including
prescribing opioids themselves, they are
much more burdensome and bureaucratic.
As a result, only a fraction of eligible
health care providers have obtained
the necessary waiver to provide this
treatment, and even those who have
are capped at the number of patients
they can treat. In addition, only certain
practitioners are eligible to apply
for the waiver, and unfortunately,
pharmacists are not among them.
Certain certification and training
requirements needed to prescribe
buprenorphine were exempted during
the COVID-19 pandemic to help expand
access to treatment, especially after the
startling drug overdose death statistics of
2020 were released. Though a positive
step, a more permanent fix is needed.
Congress is contemplating making that
permanent fix through the NABP-endorsed
Mainstreaming Addiction Treatment
Act (MAT Act) (S 445/HR 1384). The
MAT Act would eliminate the DATA
2000 waiver program while maintaining
DEA oversight of the prescribing and
dispensing of controlled substances
(CS). In addition, a community health
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