Biden Restores a Barrier to Opioid Addiction Treatment
Anonymous sources close to the White House say the Biden administration plans to reinstate special licensing requirements for physicians to prescribe buprenorphine, the most common medication used to treat opioid use disorder. Shortly before President Donald Trump left office, his administration updated federal guidelines to discontinue the “X-waiver,” a regulation that required physicians to obtain eight hours of additional training before prescribing buprenorphine for addiction treatment. Although the Biden administration has made no official decision, the Department of Health and Human Services (HHS) recently removed the relaxed guidelines from its website.
During his campaign, President Joe Biden promised to undo regulations that prevent the optimal distribution of buprenorphine. Yet one of his first actions in office reverses a policy that would have allowed unprecedented access to opioid addiction treatment.
HHS officials cited concerns about whether the department had the authority to issue guidelines that bypassed regulations set by Congress. As recently as 2018, Congress explicitly outlined requirements that physicians and other health care providers must meet to treat opioid use disorder with buprenorphine. Although the Controlled Substances Act grants HHS broad authority, in conjunction with the Department of Justice, to reclassify any federally regulated drug, the rules imposed by Congress seem to cover all drugs in Schedules III through V. Oddly, the Justice Department might be able to avoid this obstacle by moving buprenorphine from Schedule III to the more restrictive Schedule II. Another possible option: The Biden administration could completely deschedule buprenorphine. The Trump Administration didn’t attempt either approach to justify it’s guidelines, but argued HHS has the authority to “eliminate the requirement that physicians with a Drug Enforcement Administration (DEA) registration number apply for a separate waiver to prescribe buprenorphine for opioid use disorder treatment,” which would effectively cover almost all practicing physicians in the U.S.
Legal issues aside, evidence from abroad suggests that physician licensing for buprenorphine prescribing might be preventing the U.S. from better addressing unprecedented levels of opioid-related deaths (mostly involving illicit fentanyl) amid the COVID-19 pandemic. Although the previous assistant HHS secretary, Elinore McCance-Katz, warns that loosening buprenorphine restrictions could lead to black-market diversion through overprescribing, France witnessed a 79 percent drop in opioid-related de
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