As overdose rates rise due to the COVID-19 pandemic, access to Medication Assisted Treatment (MAT)—the gold standard for treating opioid use disorder (OUD)—has never been more important. Unfortunately, federal law makes it difficult for individuals with OUD to receive the lifesaving drug buprenorphine, which reduces withdrawal symptoms, prevents relapses, and reduces mortality.
To prescribe buprenorphine, medical providers must obtain a DATA 2000 “X waiver.” And even with the waiver, they still face caps in the number of patients they can treat. As of 2018, less than 5% of providers nationwide had the waiver, and 40% of U.S. Counties did not have a single provider with an X waiver. Ironically, while any provider can prescribe addictive opioids, the number of providers who can prescribe buprenorphine to treat OUD is extremely limited.
Although the X waiver should be repealed altogether, the 2018 SUPPORT for Patients and Communities Act did include provisions to loosen its restrictions by increasing the number of patients eligible to be treated by a qualified provider (from 30 to 100 people) and removing other barriers preventing providers from becoming eligible to administer MAT.
To implement these SUPPORT Act provisions, the Drug Enforcement Administration (DEA) issued proposed regulations for public comment late last year. Former U.S. Rep. Patrick J. Kennedy, founder of The Kennedy Forum, submitted comments on the proposed regulations asking the DEA to make changes and clarifications in the final regulations.
First, while the SUPPORT Act gives the DEA the authority to modify the current 14-day time period for providers to administer injectable MAT after the medication is received, the DEA has not exercised this authority despite delays in shipping from specialty pharmacies that are making the 14-day requirement a barrier to patients receiving the medications. To increase access to care, Kennedy urged the DEA to change this 14-day time period to a period of 60 days, which would allow sufficient time for shipment, processing, and administration to patients.
Second, Kennedy urged revisions to eliminate the ambiguity about who can administer injectable MAT medications. Currently, the proposed regulations are unclear whether non-waived providers can administer the treatment if prescribed by a waived provider. If non-waived providers cannot administer injectable MAT medications, patients in rural areas and other underserved communities without a waived provider will not be able to receive these desperately needed medications. This is particularly important given the increased use of telehealth, where the waived provider may be physically unable to administer the injectable MAT medication. The changes described above will improve access to life-saving MAT and fulfill the promise of the SUPPORT Act. However, President-elect Biden and the new Congress must now act to eliminate the X waiver once and for all, thus ending a discriminatory provision of federal law that is estimated to kill approximately 30,000 Americans each year.