State urges feds to deregulate addiction meds

N.Y. leading charge to loosen rules on opioid abuse treatment

New York is leading a coalition of 22 states and territories that is calling on the federal government to immediately ease restrictions on physicians looking to prescribe buprenorphine, a medication that treats opioid addiction.

On the same day that advocates took to the streets of Albany for a “die-in” to protest escalating overdose deaths in New York, nearly a dozen state health officials including New York Health Commissioner Howard Zucker called on U.S. Health and Human Services Secretary Alex Azar to expand access to the medication in response to the opioid epidemic impacting their states and the nation as a whole.

Known by the brand name Suboxone, buprenorphine is highly effective at treating opioid addiction by reducing cravings and blocking painful withdrawal symptoms. It also prevents overdose deaths by binding tightly to opioid receptors in the brain, preventing other opioids from attaching and causing respiratory depression.

“Buprenorphine is an essential tool in the fight to end the opioid epidemic,” Zucker said. “Removing federal restrictions on prescribing buprenorphine will ultimately save lives and eliminate unnecessary barriers that prevent people with opioid use disorder from having access to treatment.”

Federal policy currently limits who can prescribe buprenorphine and how much they can prescribe. Under the federal Drug Addiction Treatment Act, enacted in 2000 before opioid misuse was an epidemic, health care providers must obtain a waiver in order to prescribe the medication and then can only prescribe it to 30 patients in their first year, 100 patients in their second year, and 275 patients in their third year.

“These federal caps contribute to shortages across the country of providers who can prescribe buprenorphine,” state officials wrote in a letter to Azar dated Monday.

To obtain the waiver, physicians must complete eight hours of training and nurse practitioners and physician assistants must complete 24 hours.

While the state has been working to increase the number of providers who have waivers to prescribe buprenorphine, many still refuse to seek a waiver or don’t prescribe once they have one due to stigma, according to professionals in the field.

“Researchers in policy have noted that the waiver requirements are burdensome and reduce prescribing,” the letter says. “They have also suggested that deregulating buprenorphine would help in reducing stigma associated with treating OUD.”

Ideally, the letter states, Congress would pass legislation eliminating the waiver requirement and allowing any provider who is registered to prescribe controlled substances to also prescribe buprenorphine. Absent that change, however, state health officials recommended Azar use his authority to allow newly waivered providers to prescribe up to 100 patients immediately, rather than waiting a year.

They also pointed to federal regulations that currently limit providers from administering (but not prescribing) more than a three-day supply of opioids to mitigate opioid withdrawal. Health officials are calling for changes to the regulations that would allow a two- to four-week supply instead, since it often takes over three days for a patient to find a physician who will write a regular prescription.