According to the Centers for Disease Control and Prevention, in 2017, there were 70,237 drug overdose deaths in the United States. The vast majority of these were due to heroin, fentanyl and prescription opioids. The opioid epidemic is now killing more people than at the height of the initial HIV epidemic in the 1980s, and represents the single most profound public health crisis of our generation.
Expanding access to treatment for opioid use disorder is necessary to combat the opioid epidemic. A highly effective treatment for opioid use disorder is the medication buprenorphine. Evidence shows that buprenorphine is as effective as methadone in terms of relapse prevention and retention in treatment. However, unlike methadone, which is restricted to designated opioid treatment programs, any clinic can prescribe buprenorphine, thereby increasing access to treatment.
Unfortunately, federal policy severely limits the extent to which medical providers are able to prescribe buprenorphine. Currently, the Drug Enforcement Administration requires doctors, nurse practitioners and physician assistants to obtain a special “DATA waiver,” beyond a standard DEA license for controlled substances, prior to prescribing this evidence-based medication.
Ironically, a provider needs no additional training to prescribe opioid pain medications, which have contributed greatly to the opioid epidemic. The process to obtain this waiver is cumbersome and contributes to the stigma surrounding addiction treatment. Only approximately 5 percent of the nation’s doctors possess the DATA waiver. The majority of these physicians practice in or near urban areas, and most U.S. counties do not have a single physician with a DATA waiver. This represents a staggering shortage in the face of such a profound need for this life-saving medication.
The current DATA waiver is a way to work around the Harrison Narcotics Tax Act of 1914, which prohibited physicians from prescribing opioids to a person with addiction, because “addiction” was not considered an illness at that time. Even today, many legislators, community members and medical providers continue to suggest that substance use disorders are a moral failing on the part of the individual. This is patently false.
In the roughly 100 years since the passing of this legislation, medical science has proven addiction is a chronic illness, similar to diabetes, hypertension and asthma, in terms of heritability, relapse rates and treatment adherence. We also now have a wealth of information that shows that office-based treatment using buprenorphine is safe, effective and saves lives.
The collective consequences of inaction on the health and well-being of Americans cannot be overstated. If we are to learn from the HIV epidemic, we need to act decisively and urgently. In retrospect, we realize that stigma and prejudice played a significant role in the sluggish response to the HIV/AIDS crisis in the 1980s. Similarly, stigma and prejudice appear to be driving the inadequate response to the opioid epidemic devastating our communities.
We know that without adequate access to evidence-based treatment such as buprenorphine-naloxone, roughly 80 percent to 90 percent of individuals with opioid use disorders continue to misuse opioids and, unfortunately, an unacceptably high percentage of these individuals overdose and die. We believe that eliminating the DATA waiver requirement for prescribing buprenorphine will remove a major barrier for potential prescribers and dramatically improve access to treatment.
Pertinently, in front of Congress is House Resolution 2482 — the Mainstreaming Addiction Treatment Act. This bill, if passed, would eliminate the outdated requirement for a separate DATA waiver to prescribe buprenorphine. We strongly support this bill. We urge all readers to be an advocate in their communities by writing and talking to their legislators about expanding access to treatment by supporting this act, and by encouraging their doctors to prescribe buprenorphine.
Dr. Snehal Bhatt serves as the chief of addiction psychiatry at the University of New Mexico and has been involved in addictions treatment in New Mexico for the past 10 years. He also carries out numerous buprenorphine trainings around the state and the U.S. Dr. Richard Gadomski is a preventive medicine resident at the University of New Mexico, with a particular interest in addictions treatment and public health. Leah Nelson, a preventive medicine resident at the University of New Mexico, also contributed to this piece.