In order to facilitate social distancing among people in treatment for opioid use disorder, the Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration relaxed some onerous regulations surrounding the use of buprenorphine or methadone in Medication Assisted Treatment.
For health care providers to prescribe buprenorphine in an ambulatory setting to patients with addiction, they must apply for an “X waiver” on the narcotics prescribing license they get from the DEA. This is an onerous process that has resulted in a paltry number of practitioners with the waiver. Many addiction experts have called for the DEA to remove the requirements and last summer legislation to that effect was being discussed in Congress.
The DEA requires all patients to be seen in person before they may be prescribed a controlled substance. With medical clinics engaging in social distancing by seeing patients for only urgent matters, thinning staff, reducing hours, and minimizing the number of patients in their waiting rooms, patients on buprenorphine treatment face understandable challenges. Last week the DEA temporarily suspended the requirement that MAT patients see their prescriber in person, allowing for the use of telemedicine. This should ease the burden. Removing the X waiver requirement so that all licensed narcotics prescribers can prescribe buprenorphine to the patients with addiction, as recommended by the National Academy of Science, Engineering, and Medicine, would ease it further.
While patients on buprenorphine face challenges during the COVID-19 epidemic, patients receiving methadone treatment have it even worse. Among the many onerous requirements placed on operators of methadone clinics is the one requiring patients to take the methadone each day in front of a clinic staff member. This makes it difficult to participate in the program even under ordinary circumstances, especially if the nearest clinic is miles away. And the long queues of patients that form waiting to get inside the clinics each day are not examples of social distancing. NASEM recommends reforming methadone regulations to allow community health care practitioners to prescribe several days of methadone to patients they see and follow in their offices, as doctors in the U.K., Canada, and Australia have been doing for decades. Clinical researchers at Boston University reported on the success of a government‐approved pilot project in the primary care setting in 2018.
In response to the pandemic, SAMHSA informed states that methadone clinics may dispense up to 28 days of Take‐Home methadone to their “stable” patients and up to 14 days of take‐home methadone to patients who are “less stable” but the program believes “can safely handle this level of Take‐Home medication.”
All of these moves are moves in the right direction. They clearly foster addiction treatment compliance. When this crisis passes, making the measures permanent should be a no‐brainer. But reform should not stop there. These temporary measures should serve as catalysts for repeal of the “X waiver” and a complete revision of the DEA’s antiquated, stigmatizing approach to methadone treatment programs