The current Congress has one last chance to pass legislation that would lift a major barrier to opioid addiction medication and potentially turn the tide of the drug overdose crisis.
The Mainstreaming Addiction Treatment (MAT) Act would deregulate buprenorphine, a gold standard medication for treating opioid addiction and preventing overdose. Harm reduction activists, physicians and a litany of medical associations have spent years pushing Congress and consecutive presidential administrations to nix the so-called X-waiver, which doctors are required to obtain from the Drug Enforcement Administration (DEA) in order to prescribe buprenorphine.
Rates of fatal drug overdose were already on the rise when the COVID-19 hit and isolated drug users from friends, family and the limited number of doctors who have an X-waiver to prescribe buprenorphine. The Centers for Disease Control and Prevention (CDC) found massive racial disparities in the fatal overdose data from 2020, particularly in areas with high levels of income inequality. Researchers concluded that yearslong efforts to expand access to buprenorphine were more likely to benefit white people than Black, Brown and Indigenous people.
From 2019 to 2020, overdose deaths among white people grew by 22 percent after slowing in recent years, while overdose deaths among Black and Indigenous Americans exploded at roughly twice that rate — an increase of 44 percent and 39 percent, respectively. In 2021, drug-related deaths topped 100,000 annually, the highest level ever recorded, according to the CDC.
Now, physicians and activists are scrambling to pass the MAT Act in the Senate, where the bill has languished after passing with broad bipartisan support in the House as part of a broader mental health reform package. Advocates say the Senate’s end-of-the-year vote on omnibus federal spending legislation is the last chance the Senate has to pass the MAT Act before the current Congress expires.
Passing the MAT Act is an #ACEPAdvocacy priority and we’re working to make it happen. This thread is spot-on in explaining why removing these barriers to care is so important. https://t.co/VtmWbhau7b
— Emergency Physicians (@EmergencyDocs) November 18, 2022
At least 543 organizations endorse the MAT Act, including a long list of major medical associations ranging from the American Association of Nurse Anesthesiology to the American Academy of Pediatrics. In a letter to Senate leadership currently circulating among physicians, medical professionals call the bill a “bipartisan solution to overdose crisis.”
“Buprenorphine is considered a gold standard of care for opioid use disorder because it prevents overdoses, reduces use of opioids like fentanyl, and helps individuals achieve recovery,” the doctors wrote. “But due to outdated federal rules that prevent health care providers from prescribing buprenorphine, only about 1 in 10 people with opioid use disorder receive medications for the condition.”
With such a broad bipartisan and medical consensus on buprenorphine, observers say it’s only a matter of time before the X-waiver is lifted entirely. After appearing to drag its feet, the Biden administration issued new rules allowing certain providers to work around the X-waiver and prescribe buprenorphine to patients in need, but regulators say permanently stripping the red tape from the books would require and act of Congress.
Law enforcement is also resistant to change after orchestration a nationwide crackdown on prescription opioids that failed to reduce overdose deaths. Courts have ruled that the DEA wrongly targeted doctors and pharmacists for providing buprenorphine, and jails and prisons resisted dispensing the drug to incarcerated people, who are extreme risk of fatal overdose after being caged and forced into withdrawal.
National Institute on Drug Abuse Director Nora Volkow recently said “there’s absolutely no reason” why primary care providers shouldn’t prescribe methadone, the other gold standard for treating opioid addiction. Currently, methadone is more highly regulated than buprenorphine, with patients required to visit specialized clinics where they are put under extreme surveillance. Methadone and buprenorphine are both technically opioids, but no other painkiller is regulated like this — one reason why there is a longstanding stigma among potential prescribers.
“We have a pretty powerful health structure in the United States and we should optimize it in order to be able to maximize access to treatment for people with substance use disorders or other conditions and that includes the use of methadone,” Volkow told the STAT Summit last week.
