The omnibus bill for 2023 and proposed amendment to HHS regulations could make buprenorphine and morphine treatment more easily accessible
Overdose deaths this year eased off the all-time record in 2021, but remain at historic highs. The Centers for Disease Control forecasts around 107,000 overdose deaths this in 2022, compared with 109,000 last year.
The vast majority of these overdoses are caused by opioids, and the administration is working on plans to make it easier to obtain treatment for opioid addiction, so that more patients can access life-saving drugs.
Important interventions have been inserted in the omnibus spending bill for 2023, as well as in policy suggestions by the department of Human and Health Services.
More doctors will be able to prescribe buprenorphine
The omnibus spending bill, which is expected to pass by the end of this week, does away with the requirement that only patients who have been addicted for at least a year can be admitted to an opioid addiction treatment program. This makes treatment available for a larger percentage of users (pdf, p. 3127).
Further, the change expands doctors’ ability to prescribe medications listed in the controlled drugs schedules III, IV, and V. This is important because buprenorphine, a drug that allows patients to manage opioid abuse disorder independently, is a schedule III substance. Previously, doctors had to receive special waivers (pdf, p. 3128) to be able to prescribe it, limiting the number of patients who could access the drug.
The bill doesn’t change the criteria to prescribe and administer methadone, which acts similarly to buprenorphine, but is a schedule II substance considered at higher risk of abuse (like fentanyl, cocaine, or methamphetamine). Methadone has been in use the longest to treat opioid addiction disease, and can be used to treat pain, too, but the drug is administered via regular visits to a clinic, which can interfere with the daily life of the patient.
Telehealth and take-home methadone
The pandemic brought some changes to the administration of both methadone and buprenorphine. To limit opioid addiction patients’ potential exposure to covid, federal regulators amended rules for methadone to allow stabilized patients to take home enough doses for up to 28 days . Addiction treatment advocates have long called for thischange, saying the requirement of constant clinic visits poses an obstacle to the regular life of the patients and is a sign of mistrust in their ability to manage their condition.
At the same time, alongside other expansions in telehealth use, practitioners were allowed to prescribe buprenorphine without in-person visits. The change dramatically expands potential access to the clinic, especially in rural areas or among people who can’t easily get to doctor’s appointments.
Now, the department of Health and Human Services is seeking to make these changes permanent, as research has shown positive impact of the interventions, without the increase of methadone overdoses or abuse that some had worried about. This would be the first significant amendment to rules regulating opioid treatment in two decades.
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