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The US Finally Removes a Major Barrier to Opioid Addiction Treatment

Advocates say deregulating buprenorphine is a long overdue step toward ending the overdose crisis.

Purple flags are displayed in front of Brigham & Womens Hospital, meant to represent the thousands of lives lost to drug overdoses, on October 28, 2022, in Boston, Massachussetts.

In a major victory for public health and the harm reduction movement, the Biden administration is touting changes to federal drug law that removed a major barrier to accessing buprenorphine, a standard medication for treating opioid dependence and addiction that is crucial for preventing overdose deaths.

Advocates gathered at the White House Tuesday to celebrate the passage of the Mainstreaming Addiction Treatment (MAT) Act, which was passed by Congress and signed by President Joe Biden as part of an omnibus spending legislation last month. The new law removes the so-called “X waiver” that doctors were required to apply for and obtain from the Drug Enforcement Administration (DEA) in order to prescribe buprenorphine to people living with opioid addiction.

Many doctors did not know about the X waiver or simply did not apply due to the stigma around treating patients with intractable pain or substance use disorders. As a result, the vast majority of physicians in the United States could not prescribe buprenorphine to patients suffering from conditions such as painkiller withdrawal or heroin addiction.

Ellen Glover, the drug policy and harm reduction campaign director at People’s Action, said federal agencies recently removed X waiver requirements from the books and updated their websites to reflect the change. Advocates are now getting the word out to doctors and potential patients.

“We’ve got grassroots folks across the country, and part of our responsibility is for people to know that this has happened, and so we are also doing a lot of outreach to clinics and community members,” Glover said in an interview with Truthout while on her way to the White House.

Rahul Gupta, director of the White House Office of National Drug Control Policy, said the change is a bipartisan achievement that will encourage doctors to treat opioid addiction like any other condition. Advocates say the X waiver should have been removed years ago as the overdose crisis was spiraling out of the control.

“This is a game changer, I’ll tell you the nature of this is a huge game changer,” Gupta said during a White House event on Tuesday.

The DEA and other law enforcement ruthlessly targeted doctors and cracked down on opioid prescribing over the past decade, shrinking both the legal and illicit market for pain pills and pushing dependent users toward more dangerous substances such as fentanyl. Police were gripped by the idea that prescription opioids, including lifesaving buprenorphine, were being “diverted” to people without prescriptions. Gupta said new research shows the fear of buprenorphine “diversion” contributing to the overdose crisis was never grounded in science. Still, the crackdown on prescribing led to the shuttering of clinics and left patients with nowhere to turn.

The X waiver and other barriers prevented people living with addiction from accessing treatment, and the number of fatal drug overdoses skyrocketed, especially among Black, Indigenous, and other communities of color. The pandemic added fuel to the fire, isolating patients and drug users from social and health supports. The number of annual estimated drug overdose deaths grew by 15 percent in 2021 alone and surpassed 100,000, the highest level ever recorded.

Reformers are now setting their sights on methadone, the other standard medication for treating opioid dependence and addiction. Methadone is currently only dispensed at specialized clinics that subject patients to intense surveillance, but the pandemic lockdowns forced regulators and law enforcement to loosen their rules and embrace telehealth services. The administration is now working to make those changes permanent, according to Gupta.

Nora Volkow, director of the National Institute on Drug Abuse, recently said primary care providers should “absolutely” be allowed to prescribe methadone and allow patients to pick up the medication at regular pharmacies.

However, fentanyl and other powerful opioids are not the only drugs causing overdose deaths, which often involve simultaneous consumption of alcohol or other substances. While methadone and buprenorphine are important tools for treating opioid addiction, Glover said people should have access to tools and health care regardless of drug use.

“Our long-term solution is increasing access to tools for all drug use, so folks can stay alive,” Glover said. “No matter what type of drug, or what their relationship is to this substance, or how much money they have, or what they look like — everyone has what they need to stay safe and alive.”

Following years of advocacy by grassroots organizations and medical experts, the Biden administration has embraced harm reduction, the broad array of methods employed by providers and drug users to make drug use safer. Despite belligerent and stigmatizing attacks from the right, the administration is funneling millions of dollars in grant funding toward syringe exchange clinics and other harm reduction providers in local communities.

However, Biden and his administration has also doubled down on the failed “war on drugs,” pledging to increase the number of police on the streets and crack down on drug trafficking at home and abroad. Criminalizing drugs and the people who use them did not prevent the overdose crisis, and advocates argue that heavy policing is only making the crisis worse.

Indeed, federal data shows massive racial disparities in overdose fatalities, which reflects the fact that efforts to expand access to addiction treatment have disproportionately benefited white people, while people of color are more likely to be denied medical care or arrested by police.

“We know now in this country that color of your skin, your relationship to substances and how much money we have in your pocket, really can determine whether you end up in treatment, incarcerated or dead,” Glover said.

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