Physicians and advocates are concerned that a federal proposal to roll back pandemic policies that would allow remote prescribing of common opioid alternatives could put people recovering from addictions at risk. increase.
With the public health emergency scheduled to end on May 11, the Drug Enforcement Administration’s proposal requires you to visit a doctor or clinic within 30 days of getting a telemedicine prescription for buprenorphine.
The proposal could change the way more than one million Americans recovering from addiction access this opioid alternative drug used to stop cravings and block withdrawal symptoms in opioid use disorder. I have.
Since 2020, the federal government has allowed telemedicine providers to prescribe medicines without visiting a doctor, ensuring people have access to medicines during lockdowns and reducing COVID exposure .
The DEA, which regulates controlled substances such as buprenorphine, believes in-person visits are a necessary compromise to allow people to obtain drugs from telemedicine providers while reducing the likelihood that buprenorphine will be diverted for illicit purposes. Under the proposed rule, officials say doctors will also be able to order tests, such as drug and poison screenings, and check for infectious diseases such as hepatitis.
The DEA said the agency will consider more than 2,900 public comments when drafting the final rule. The agency has not announced when to announce final rules, which he expects after the public health emergency ends on May 11.
As overdose deaths rise, experts want to make buprenorphine more accessible
Proponents warn the new rules could disrupt access and make it difficult for some to continue recovering from opioid use disorders. People living in remote areas may have trouble getting doses.
Kevin Roy is Chief Policy Officer for Shatterproof, a non-profit addiction treatment organization.
He said studies show that concerns about buprenorphine being misused or diverted are “not a concern.” It cited research from the National Institutes of Health and the Centers for Disease Control and Prevention. did not increase After teleprescribing is allowed.
Roy sees little purpose in the DEA’s proposed rule, as studies show that medication was not diverted and deaths from buprenorphine did not increase.
“What problem are they trying to solve with that 30-day limit?” Roy said.
Nearly 107,000 US residents will die from drug overdoses in 2021. About 75% of these deaths involved opioids, mostly illicit fentanyl.
“We need to work with people to make it as easy as possible to start or continue buprenorphine and other addiction medications to combat the stubborn number of overdose deaths.
Some also worry that people will not be able to get medical appointments if they have to go to a hospital or clinic to get a prescription. There is already a shortage of health care providers who prescribe naltrexone.
In public comment, the National Rural Health Association said the DEA’s proposal was “overly restrictive” and “leads to dangerous interruptions in maintenance treatment that can destabilize current patients and cause relapses and overdoses.” He said it was risky.
The Rural Association says telemedicine is essential because about a third of rural residents live in counties without doctors or clinics offering buprenorphine treatment.
Others say the DEA’s rule will penalize telemedicine providers who make up for the shortage of telemedicine providers. This is especially true in rural areas and areas where there is a shortage of doctors willing to prescribe.
“Telehealth has really closed a huge gap for people,” said Jason Gibbons, a health economist at Johns Hopkins University. “It’s just another barrier to access.”
Gibbons studied how missed doses of buprenorphine affect patients.and study Of the 34,505 patients, those who missed a dose were almost two to four times more likely to overdose than those who took it regularly.
Gibbons said remote prescribing options would make it much easier for people to stay on their medications. A shortage of prescribing physicians has been a long-standing problem. He did not have a single doctor or clinic prescribing buprenorphine in 40% of U.S. counties, according to the 2020 Department of Health and Human Services Inspector General’s Report.
This makes it difficult for people without transportation to reach clinics that are far away. Taking time off from work and making childcare arrangements can also be difficult, says Lenny Johnson, an associate professor at the Johns Hopkins Bloomberg School of Public Health.
While requiring to see a doctor within 30 days sounds like a good idea, Johnson said it could deter people who are already facing a difficult situation. , “It’s about making it really easy to get on the ramp to recovery and stay on the ramp to recovery,” she said.
veteran
Army veteran Bill Bradley worries that the DEA’s proposals could disrupt the routines of many people in recovery.
Bradley lives in Fairmont, West Virginia, where there are no doctors or clinics that prescribe buprenorphine.
Several years ago, the community opened temporary shelters for the homeless and those in need of food, clothing and hygiene items. People with drug addiction problems can meet with a licensed social worker or recovery coach. said Mr Bradley.
If the DEA’s proposal is adopted, these residents will have to travel more than 12 miles north to Morgantown and more than 20 miles south to Clarksburg for an appointment with a prescribing doctor.
Bradley has been on buprenorphine for over a decade after becoming dependent on prescription opioid pain relievers to treat kidney stones. His doctor in Pittsburgh allows him to buy buprenorphine by mail order. Transportation will also be provided through the Department of Veterans Affairs if medical attention is required.
But he worries that other people in his town won’t keep taking buprenorphine if they have to leave town for medical appointments. , I don’t have the money to take a taxi or an Uber.
“I’m afraid I’m going to put them back to, ‘Let’s get something closer. We’re just going to pick up[illegal drugs]again,'” Bradley said.
Addiction drugs ‘greatly underutilized’
Nora Volkow, director of the National Institute on Drug Abuse, said drugs to treat opioid use disorders “continue to be very underused.”
Congress has aimed to make it easier for more doctors to prescribe drugs. Last December, President Joe Biden signed into law the Mainstream Addiction Treatment Act, which removes the waiver doctors had to secure before prescribing buprenorphine. , taking buprenorphine and other medications to treat addiction.
“Expanding more equitable access to these medicines for people with substance use disorders is an important part of our national response to the overdose crisis,” Volkow said in a news release. rice field.
Ken Alltucker can be found on Twitter at @kalltucker or emailed at [email protected].
