UPDATE: Congress recently passed the Mainstreaming Addiction Treatment (MAT) Act as part of the Consolidated Appropriations Act of 2023, removing the buprenorphine waiver requirement. Partnership to End Addiction has long supported removing the waiver requirement and advocated for passage of the MAT Act, and we applaud Congress for taking this step. We look forward to ensuring effective implementation of this critical change.
Partnership to End Addiction supports reducing barriers to effective substance use disorder treatment, including eliminating the DATA 2000 waiver required to prescribe buprenorphine. Nonetheless, we stress that other policy changes are needed to ensure more people receive effective care. The buprenorphine requirement should be eliminated because (1) it has failed to meet its ostensible purpose, which is to prevent unscrupulous prescribing and diversion and (2) it has limited access to an effective opioid addiction medication during an unprecedented opioid epidemic. With preliminary estimates of 191 people dying every day from an opioid overdose in 2020, access to effective treatment is more critical now than ever before. The current waiver requirement is completely incompatible with the goal to increase access to evidence-based treatment for opioid use disorder (OUD).
Instead of reducing diversion, the waiver requirement contributed to diversion of buprenorphine for self-treatment because it made treatment unavailable.[1] The DEA did not use waiver requirements to reduce diversion of any other medication, including prescription opioids where diversion of such medications has resulted in unquestionable societal risk and harm. The differential treatment of buprenorphine versus other narcotic pain relievers was driven by stigma rather than science and resulted in discrimination against patients with OUD. There was no clinical justification for imposing a patient limit, training and administrative requirements associated with prescribing buprenorphine. In fact, providers who prescribed oxycodone, a DEA Schedule II drug, or who prescribed methadone or buprenorphine for pain were not subject to these same restrictions. The only difference was that the patients to whom buprenorphine was prescribed were undergoing treatment for addiction. Given the effectiveness of buprenorphine in treating OUD, a life-threatening disorder, and the limited access to care, we find it unconscionable that the government singled out this treatment with patient limitations.
Efforts to reduce unscrupulous prescribing, in fact, reduced overall prescribing of buprenorphine. A very small number of providers had obtained the waiver and fewer actually prescribed buprenorphine.[2] The waiver requirement created the perception among providers that it is difficult or challenging to treat substance use disorders (SUD), perpetuating stigma and discouraging providers from engaging in the practice.
We understand that eliminating the waiver requirement, alone, is insufficient to increase access to buprenorphine and other effective SUD care. We are encouraged that in addition to eliminating the waiver requirement, Congress is increasing training requirements for health care providers. Other necessary reforms include providing adequate reimbursement, as well as ensuring providers have support and guidance from more experienced providers to consult on complex cases as well as support staff, such as nurses, social workers, and peers to meet patients’ needs adequately.[3]
To ensure prescribers can hire appropriate support staff and to increase availability of ancillary services, reimbursement rates must be increased. One possible reason for the shortage of quality behavioral health services is low insurance participation and reimbursement. Lack of insurance coverage is also cited as a barrier to prescribing buprenorphine.[5] A number of states have increased access to and quality of buprenorphine treatment by changing reimbursement policies in Medicaid.[6] These strategies should be replicated on the national level and applied in other insurance products, to ensure adequate access to effective addiction treatment.
In summary, removing the buprenorphine wavier requirement is an important policy change but it must be accompanied by other innovative policies to significantly increase access to effective OUD treatment. Partnership to End Addiction supports eliminating the DATA 2000 waiver requirement, together with funding and requirements for provider training and increased reimbursement rates for SUD treatment, to increase access to life-saving care.