By Felicia Salcedo, Program Manager, Overdose Prevention and Response Program
Medications to treat opioid use disorder are an important option for people struggling with opioid use disorder. But it is not always easy for someone to walk into a provider’s office and start on a treatment path. Providers also faced barriers to offering these medications, with requirements to go through what is known as a waiver process to be able to start treating patients. But now, one less barrier stands in the way between providers and patients as a result of a recent federal rule change.
On April 27, the U.S. Department of Health and Human Services announced new regulatory changes for prescribing buprenorphine for opioid use disorder (OUD), loosening restrictions to allow more medical providers to treat patients with the condition. The rule change significantly impacts the potential availability of treatment for OUD by eliminating a mandatory training and waiver process for providers who treat 30 or fewer patients at one time.
We sat down with Brad Finegood, Public Health – Seattle & King County’s Strategic Advisor on Behavioral Health, to learn more about the new rule change and how it may impact treatment access in our community.
What is the rule change and why is it important?
Buprenorphine is an evidence-based treatment and, like methadone, is considered the “gold standard” of medical care for OUD. It significantly reduces risk of death for people with OUD. Unlike methadone, buprenorphine can be prescribed in an office-based setting, such as a primary care clinics or hospitals, but the previous waiver requirements were a barrier because providers had to go through significant training in order to offer this life-saving treatment.
The regulatory change comes at a time of steep rise in fentanyl-involved deaths and ever-increasing opioid overdoses. The Centers for Disease Control and Prevention estimate that more than 88,000 people died of drug overdoses from September 2019-August 2020, the highest number of overdose deaths ever recorded in the U.S. in any 12-month period. In King County, drug overdoses have followed this national trend. Specifically, fentanyl-involved deaths increased from 3 fentanyl involved-overdoses in 2015 to 172 overdoses in 2020.
How do you see the new rule change impacting the availability of treatment for OUD in the community?
Requiring a waiver to prescribe buprenorphine created an unnecessary hurdle for providers to treat patients with OUD. The rule change will now allow more people to access treatment in a variety of medical settings from hospitals to primary care clinics, instead of needing to go to a specialty addiction medicine clinic for treatment.
As a greater number of providers are able to work with patients on their treatment plans, there is potential to also reduce stigma among providers, patients and the broader community and to further integrate treatment for substance use disorder into what is considered the range of care that patients may need. Hopefully, this shift will make it so that people feel comfortable seeking treatment where they are already receiving medical care.
What are you hearing from physicians about the rule change?
As my colleague, Dr. Callan Fockele, an emergency room physician at Harborview Medical Center reflected, “The unnecessary hurdle of the x-waiver has meant emergency departments have historically undertreated patients with opioid use disorder. This policy change gives us a unique opportunity to expand access to low-barrier buprenorphine and save lives.”
Over several years, we’ve also heard from some providers that the waiver requirement may be contributing to the stigma associated treating patients with OUD in primary care settings.
According to Dr. David Sapienza an addiction medicine doctor with Public Health – Seattle & King County, “These changes are a step in the right direction, but still leave too many barriers to treating opioid use disorder like other medical conditions. Buprenorphine is a safe and effective medication that should not require additional regulations or certification to prescribe. There is no reason to treat it differently than other medications we prescribe and doing so contributes to the stigma and difficulty accessing care that many with opioid use disorder encounter when they reach out for care.”
How has King County worked to provide access to medications for people with Opioid Use Disorder and why is this important now?
The King County Heroin and Prescription Opioid Taskforce recommended expansion of buprenorphine far and wide as a priority strategy in 2016. Since that time, the number of locations where people can receive buprenorphine in the community has grown from 40 locations to over 160. King County has also expanded access to medications at critical locations like hospitals, community health clinics, jails, and needle exchanges.
We know that we need to meet people where they are at and reduce as many barriers to care as possible. This continues to be the case with the dramatic increase in deaths involving fentanyl. Fentanyl is a powerful synthetic opioid drug, but fentanyl use is treatable with buprenorphine or methadone—making access to these life-saving medications even more critical now.
How would doctors and prescribers get signed up to provide buprenorphine for OUD?
Doctors, Nurse Practitioners and Physician Assistants can prescribe buprenorphine to 30 patients at any given time. They can register through the U.S. Substance Abuse and Mental Health Services Administration’s website. Training and support are available for prescribers who are interested in learning more through the national Provider Clinical Support System.
If I am someone seeking treatment where do I go?
Individuals in need of treatment or resources can start by asking their provider if they are able to prescribe buprenorphine. If individuals do not have a provider or their provider still does not prescribe medicine for OUD, the Washington Recovery Helpline is a one stop shop for information and referrals. They are available 24 /7 and can connect people to other options and supports like methadone, behavioral health counseling and family support services. Washington Recovery Helpline 866-789-1511.
The University of Washington Alcohol and Drug Abuse Institute also maintains a comprehensive resource list to learn more about treatment options at www.learnabouttreatment.org.
Originally posted May 17, 2021