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Katiri Zuluaga

Manager, State Initiatives

Legislation Eliminating Buprenorphine Waivers Introduced in House

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A bipartisan piece of legislation has been introduced in the House that would remove restrictions on health providers to prescribe buprenorphine, a medication proven effective in treating opioid use disorder. The Mainstreaming Addiction Treatment Act (H.R.2482) would eliminate the requirement for medical providers to obtain a waiver from the Drug Enforcement Administration (DEA) to treat opioid use disorder with buprenorphine or any other Schedule III, IV or V drug. Currently, practitioners must apply for the waiver in order to prescribe buprenorphine specifically to treat addiction, even though they may be able to prescribe the medication for other reasons.

Background: The Opioid Epidemic Continues

Communities across the United States continue to be hit hard by the opioid epidemic. According to the National Institute on Drug Abuse, nearly 48,000 people died due to an opioid overdose in 2017. Only one in five individuals with an addiction are getting the treatment needed to manage their substance use disorder. Medication-assisted treatment in concert with regular counseling is considered the gold standard for addiction treatment.

The Issue: Buprenorphine Waivers

In order to dispense buprenorphine for detoxification or addiction treatment purposes, physicians must qualify for a waiver from the DEA. This requires eight hours of training and completion of an application to the Substance Abuse and Mental Health Services Administration (SAMHSA), after which approved physicians receive a prescriber number that must be included in all future prescriptions for buprenorphine to treat addiction. Once a physician receives their waiver, they can prescribe medication to a maximum of 30 patients for opioid dependence and after a year are able to submit another application to increase the number of patients to 100 and can eventually serve up to 275 patients. Proponents of the waiver system describe the process as antiquated and burdensome, and that ability to prescribe to only 30 people in the first year hinders the ability of physicians to adequately address the crisis.

The Legislation: Mainstreaming Addiction Treatment Act

The lead sponsors of the Mainstreaming Addiction Treatment Act are Rep. Paul Tonko (D-NY), Rep. Antonio Delgado (D-NY), Rep. Ben Ray Lujan (D-NM), Rep. Ted Budd (R-NC), Rep. Elise Stefanik (R-NY), and Rep. Michael Turner (R-OH). The bipartisan Congressional delegation believes that this bill will increase access to life-saving treatment by removing bureaucratic barriers and decreasing illicit diversion of buprenorphine. In addition to removing the waiver process specifically to prescribe buprenorphine, the bill also includes the removal of any waivers required for all Schedule II, IV and V narcotics under the Controlled Substances Act that are used to treat opioid use disorder. The bill would require the Secretary of Health and Human Services (HHS) to launch a national campaign educating clinicians about the changes and encouraging the integration of addiction treatment.