New Guidelines Will Make Opioid Addiction Medications More Widely Available

• New federal guidelines are loosening restrictions on prescriptions for the opioid addiction medication buprenorphine.
• The new rules ease training requirements and lift some limits on how many people a medical professional can prescribe the drug.
• Experts say the new guidelines will help save lives, although they say more still needs to be done.

The Biden administration has released new guidance that makes it easier for doctors and other medical practitioners to prescribe potentially life-saving opioid treatment medications.

Previous guidelines required health workers to receive additional training, including an 8-hour course for physicians and a 24-hour course for all other medical professionals, to prescribe buprenorphine – known more commonly under the brand name Suboxone – to people addicted to opioids.

It also required doctors to refer patients to counseling services.

The new guidelines provide exemptions to those requirements.

A low participation rate in the training program has meant that in some places people with opioid addictions could not find someone to prescribe the drug.

Under the old guidelines, doctors were also limited on the number of people they could prescribe buprenorphine.

“Waivered providers can only prescribe buprenorphine to a limited number of patients at a given time and must comply with or certify to other requirements,” Lindsey Vuolo, MPH, vice president of health law and policy at the Partnership to End Addiction, told Healthline. “The number of patients that a waivered provider can prescribe to at any given time ranges from 30 to 275 patients, depending on the provider’s prescribing history. There are no other medications for which healthcare providers can only prescribe to a limited number of patients.”

The new guidance lifts those limits for healthcare workers treating 30 people or fewer, although it keeps those limitations in place for those seeking to treat up to 275 people.

Nearly 50,000 people died from opioid overdoses in 2019, the most recent year for which there’s data, according to the Centers for Disease Control and Prevention (CDC).

“Substance use disorder is a disease that affects the whole person and often can have impacts on patients’ overall health. One goal of this policy change is to encourage providers in primary care settings to screen, diagnose, and treat opioid use disorder patients that they may encounter in their practices,” said Alexis Geier-Horan, MPP, vice president of governmental relations for CleanSlate, a provider of individualized, medication-assisted treatment of opioid addiction.

“This change facilitates emergency room and other healthcare providers who briefly encounter opioid-dependent patients in settings such as the ER, ICU, and outpatient clinic in starting patients on the medication and then referring them to specialty care,” Geier-Horan told Healthline.

Advocates want more

Since 1999, 841,000 people have died of a drug overdose, according to the CDC. The majority of those deaths have been opioid-related.

Buprenorphine isn’t the only treatment for opioid addiction.

Naltrexone, which is not a controlled substance, is widely available, while methadone has strict prescribing and dispensing requirements that remain unchanged.

“Both methadone and buprenorphine activate the brain’s opioid receptors to manage opioid withdrawal and cravings. While both of these medications are opioids, they cause a less intense euphoric rush than heroin or prescription opioids,” Vuolo said. “Nonetheless, there is tremendous stigma against methadone and buprenorphine because of an incorrect belief that they ‘replace one addiction for another’ even though there is a large body of evidence demonstrating that these medications are effective for reducing death, overdoses and illicit opioid use.”

To combat this federally acknowledged epidemic, advocates say the government needs to go further on supporting people who face opioid addiction and increasing access to life-saving medication.

“Access is the first step in building healthy, connected, and supportive communities,” Robin Newhouse, PhD, dean of the Indiana University School of Nursing, told Healthline. “There are other factors that need to be considered, including integrated, coordinated care among services (such as infection control, mental health), payment for services, and quality metrics to monitor policy clinical and economic outcomes.”

Additional steps to combat the opioid crisis include removing waiver limits on how many people professionals can treat, experts say.

“The vast majority of medication-assisted treatment providers are working in specialty treatment settings, often at the top of their waiver limits,” Horan said. “Expanding these providers’ capacity to treat more patients will likely have a much bigger and more immediate impact on expanding access treatment in the U.S.”

“We have gone far enough when all people with opioid use disorder have access to the treatment they seek and need,” Newhouse added.

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