Skip to content Skip to footer

Congress Has One Last Chance to Turn the Tide of the Overdose Crisis

Doctors urge the Senate to vote on bipartisan legislation that would expand access to lifesaving buprenorphine.

People who lost relatives to a drug overdose sit among imitation graves set up near the US Capitol in Washington, DC, on September 24, 2022.

Part of the Series

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.

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 an 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.

Ellen Glover, director of the drug policy and harm reduction campaign at People’s Action, a group that organizes grassroots activists around federal policy, said the MAT Act has more co-sponsors than 99.9 percent of the dozens of other bills before the current Congress.

“Yet, we’ve lost over 108,000 people from overdose in the last year, and Congress hasn’t moved any legislation this year to stem the tide of death,” Glover said in an email. “Every death is a policy failure.”

Truthout Is Preparing to Meet Trump’s Agenda With Resistance at Every Turn

Dear Truthout Community,

If you feel rage, despondency, confusion and deep fear today, you are not alone. We’re feeling it too. We are heartsick. Facing down Trump’s fascist agenda, we are desperately worried about the most vulnerable people among us, including our loved ones and everyone in the Truthout community, and our minds are racing a million miles a minute to try to map out all that needs to be done.

We must give ourselves space to grieve and feel our fear, feel our rage, and keep in the forefront of our mind the stark truth that millions of real human lives are on the line. And simultaneously, we’ve got to get to work, take stock of our resources, and prepare to throw ourselves full force into the movement.

Journalism is a linchpin of that movement. Even as we are reeling, we’re summoning up all the energy we can to face down what’s coming, because we know that one of the sharpest weapons against fascism is publishing the truth.

There are many terrifying planks to the Trump agenda, and we plan to devote ourselves to reporting thoroughly on each one and, crucially, covering the movements resisting them. We also recognize that Trump is a dire threat to journalism itself, and that we must take this seriously from the outset.

Last week, the four of us sat down to have some hard but necessary conversations about Truthout under a Trump presidency. How would we defend our publication from an avalanche of far right lawsuits that seek to bankrupt us? How would we keep our reporters safe if they need to cover outbreaks of political violence, or if they are targeted by authorities? How will we urgently produce the practical analysis, tools and movement coverage that you need right now — breaking through our normal routines to meet a terrifying moment in ways that best serve you?

It will be a tough, scary four years to produce social justice-driven journalism. We need to deliver news, strategy, liberatory ideas, tools and movement-sparking solutions with a force that we never have had to before. And at the same time, we desperately need to protect our ability to do so.

We know this is such a painful moment and donations may understandably be the last thing on your mind. But we must ask for your support, which is needed in a new and urgent way.

We promise we will kick into an even higher gear to give you truthful news that cuts against the disinformation and vitriol and hate and violence. We promise to publish analyses that will serve the needs of the movements we all rely on to survive the next four years, and even build for the future. We promise to be responsive, to recognize you as members of our community with a vital stake and voice in this work.

Please dig deep if you can, but a donation of any amount will be a truly meaningful and tangible action in this cataclysmic historical moment.

We’re with you. Let’s do all we can to move forward together.

With love, rage, and solidarity,

Maya, Negin, Saima, and Ziggy