Surge in opioid deaths sparks renewed calls to deregulate key addiction treatment drug, buprenorphine

Drug overdose deaths have soared to record highs during the pandemic. That has sparked a debate over the ease of prescribing the addiction treatment medication buprenorphine, a synthetic opioid that can be prescribed for a month at a time. The issue is especially pressing since patient access to buprenorphine and other medication-assisted treatment (MAT) is limited in many areas, especially rural. Only 18% of the 1.6 million Americans who struggle with opioid addiction are receiving any kind of MAT, Christine Vestal reports for Stateline.

Doctors, nurse practitioners and physician assistants must take an eight-hour online course and submit to Drug Enforcement Administration oversight to be allowed to prescribe buprenorphine. A growing number of medical experts say it's unnecessary red tape, "but opioid addiction treatment providers and a major patient group argue that, in fact, more training is needed to protect patients. Some also worry that looser rules will result in the pills being resold illegally," Vestal reports. "The Biden administration and Congress are set to decide whether revoking provisions in the two-decade-old federal narcotics law that require the training is worth the potential harm of pills becoming more readily available."

One reason for controlling buprenorphine prescriptions is the fear that the drug might make it onto the streets. Dr. Shawn Ryan, an addiction specialist on the board of the American Society of Addiction Medicine, told Vestal he supports eliminating the training requirement because buprenorphine diversion to illegal markets hasn't been a serious public health problem.

"But addiction treatment providers who are not physicians argue that the training requirement is needed to ensure quality treatment," Vestal reports. That includes Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. "Instead of removing the guardrails designed to protect patients, Parrino argued, the federal government should consider policies that would increase Medicaid and private insurance reimbursement rates for treatment with buprenorphine and remove time-consuming pre-authorization rules that impede access to the medication."

Buprenorphine was approved for opioid addiction treatment in 2000, but medical experts have long argued over whether it should remain regulated. "heated up last month when the Trump administration proposed eliminating the training rule without congressional action. In a Jan. 14 announcement, the Department of Health and Human Services said it would publish 'practice guidelines' exempting physicians from the requirement," Vestal reports. The Biden administration put that initiative on hold and promised to examine the issue and find ways to increase access to buprenorphine. On Feb. 8 a small bipartisan group of lawmakers from the House and Senate asked Biden to work with Congress to quickly eliminate the training requirement, citing a bill filed by Sens. Maggie Hassan, D-N.H. and Lisa Murkowski, R-Alaska. 

"According to the bipartisan group, the training requirement 'reflects a longstanding stigma around substance use treatment and sends a message to the medical community that they lack the knowledge or ability to effectively treat individuals with substance use disorder,'" Vestal reports. "It’s unclear how quickly Congress might move on the buprenorphine proposal, but a recent warning from the federal Centers for Disease Control and Prevention about a surge in drug overdose deaths adds urgency to the issue. According to provisional CDC death data, more than 83,000 people died of drug overdoses, primarily related to opioids, in the 12 months ending June 2020—a more than 21% increase over the previous 12 months."