Eliminating the D.E.A. waiver and prescribing buprenorphine through telemedicine: An open problem in opiate use disorder
Doctors would be able to prescribe buprenorphine if the Drug Enforcement Administration waiver that they have to apply for is not needed. It would enable community health aides to dispense this medication as long as it’s prescribed by a doctor through telemedicine. And it would give the Substance Abuse and Mental Health Services Administration responsibility to start a national campaign to educate health care practitioners about medications for opioid use disorder. Reams of data have shown and addiction specialists agree that these medications offer some of the best options for preventing overdoses and helping people into recovery. A report by the National Academies of Sciences, Engineering and Medicine found that less than 20 percent of people who are eligible have access to them.
There is a lack of understanding about how the drugs for opiate use disorder work, among other reasons. There isn’t enough doctors willing to treat addiction in the first place. Lawmakers will have to find ways to ensure addiction treatment gets the same rates as other chronic conditions if they are to get rid of the D.E.A. waiver. Eliminating the waiver is still a crucial step towards the right direction. The prescription drugs that caused the current epidemic should not be easier to access than the medications that could help alleviate it.
Narcan, a prescription-free overdose reversal drug in the United States, is not a medicine for opioids: The Tonko MAT Act
The MAT Act, written by Congressman Paul Tonko of New York, was included in a larger mental health package and has already passed the House.
A committee of advisers to the Food and Drug Administration this week voted unanimously in favor of making Narcan, a nasal-spray version of the generic drug naloxone, available without a prescription.
In recent years, the overdose reversal drug Narcan has a strong track record of reversing fatal overdoses because it is an easy-to-use spray.
“I’ve experienced being Narcaned, I want to say, about a half dozen times in my life. It kept me alive. You have to give people a chance to stay alive,” she says.
The head of the White House office of drug control policy pointed out at a press conference that 80,000 Americans died from opiate overdoses last year.
“For the sake of the public and saving lives, I believe this medication should be available over the counter to the public as soon as possible,” said Dr. Katalin Roth, a professor of medicine at the George Washington University School of Medicine & Health Sciences, after Wednesday’s panel vote.
Kramer says the goal is to have Narcan so widely available that it’s everywhere, ready in people’s purses, in school classrooms, in shops and businesses, whenever someone overdoses.
“I am very concerned about the price,” says Nabarun Dasgupta, drug researcher at the University of North Carolina who also works with a nonprofit that distributes free naloxone to active drug users.
“If we have this resource scarcity mentality, that this is an expensive product, then people will not take enough kits to do what they need to do,” he says.
The Narcan won’t help some of the existing efforts that work to get the medication to many communities on the frontlines of the addiction crisis.
Drug overdose deaths in July were still 25% higher than they were two years earlier and 50% higher than they were five years earlier. And the types of drugs involved in fatal overdoses has changed.
Synthetic opioids, primarily fentanyl, were involved in more than two-thirds of overdose deaths, according to the latest provisional CDC data. In nearly a third of cases, the drug was involved.
According to a statement from the White House Office of National Drug Control Policy, Fentanyl and methamphetamine are often found in combination with other drugs.
“While we continue to see a flattening in overdose deaths, the Biden-Harris Administration remains focused on getting more people with addiction connected to the care they need, preventing fatal overdoses with naloxone, stopping illicit fentanyl from moving into communities, and going after drug traffickers’ profits through targeted sanctions,” Gupta said.
Obtaining and monitoring more real-time data on opioid overdoses that do not end in death could help predict where overdose deaths are more likely to happen and where there might be an increased need for first responders as well as the life-saving medication naloxone, which temporarily reverses the effects of an opioid overdose, Gupta said last week.
According to Gupta’s statement from Wednesday, emergency medical services responded to more than 390,000 activations nationwide that involved the administration of naloxone in the 12-month period ending in July – nearly four for every fatal overdose in the same timeframe.
The statement also highlights that hundreds of thousands of pounds of illicit drugs had been seized both domestically and by US Customs and Border Protection.
Rarely Get Life-Saving Medicines for People Addicted to Opioid Substances: A Study of Medications for Addiction
“If somebody has access to these life-saving medications, it cuts their mortality risk by 50 percent,” says Dr. Linda Wang, a researcher who treats patients with addiction at Mount Sinai Hospital in New York City.
As a result, public health officials say only one in 10 Americans struggling with addiction ever receive treatment. Studies show access to treatment is difficult for people of color.
Those policies left millions of people vulnerable as the powerful, toxic synthetic opioid fentanyl spread in the U.S., making addiction even more dangerous.
“There were significant barriers that were quite stigmatizing for patients as they enter treatment,” says Dr. Neeraj Gandotra, chief medical officer for the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency that oversees addiction.
Gandotra points out that people who do manage to get a drug sometimes need to visit a government-approved clinic multiple times a week to get the drugs.
There is a significant barrier to overcome because of the idea that they don’t have the right to take their drugs at home.
He said there was no evidence that diversion increased or risk increased, but that people who gained access to treatment did better.
The rule-change proposed by the Biden administration would make those reforms permanent. It would eliminate waiting periods for access to drugs, and expand options for other healthcare providers.
The term “detoxification” will be eliminated from federal rules for addiction treatment programs under plans by the SAMHSA.
She was prescribed the drug in order to allow her to return to school to get her PhD in justice studies.
She says that she experienced years of stigma within the treatment system and felt less like a patient and more like a criminal.
Russell claims that she was finally allowed to take home a single supply of her medication at a time. That spared her the near-daily trips to the nearest clinic, a 45-minute drive from her home in Phoenix.
Only a limited number of approved programs will be able to offer methadone, since it is heavily regulated.
Some addiction experts and government officials say the ultimate goal is for opioid recovery medicines to be regulated like medications for other chronic diseases.
Do prescription changes really solve the opioid overdose crisis? An addiction specialist says the FDA isn’t saying it’s a good idea
I don’t think it’s wise to say if the rule change is a step toward that. “I’m not sure how far along we still have to go, but we believe it is.”
Hurley, the addiction specialist, said if the FDA drops the prescription requirement, that also means people who can afford the product can walk into a pharmacy without worrying about whether the pharmacists there have completed the training required to distribute Narcan.
He added that it would not solve the problem of getting Narcan to those who need it because they have to pay for it.
Prioritizing a medication that can save lives, she said, helps chip away at the stigma people who use drugs often face — stereotypes that can lead to discrimination against communities and distract from efforts to confront the crisis.
“It means we are able to address the fact that there are some solutions that are within our grasp, and we’re able to move past the stigma that drives the overdose crisis,” she said. “We’re not helpless in the face of this crisis.”