How Can Federal Agencies Crush the Opioid Crisis?

A recent opinion piece on TheHill.com laid out a plan for now and the future. It offered simple steps for enlisting federal support to get those struggling with substance abuse the help they need. How simple is this solution? The title says it all: “3 ways to combat addiction during and after COVID-19.”

Life during the pandemic is proving burdensome for us all. The challenges are myriad. Among them, the resulting social isolation creates a harsh toll on those with opioid use disorder (OUD). What’s more, the undue stress of this dangerous and uncertain time makes recovery more difficult and relapses more prevalent.

Now, more than ever, the government should support this at-risk segment. How and what should be done? The author, who heads the substance use prevention and treatment initiative at Pew Research, outlines an approach.

1: Expand Access to Addiction Treatment

To begin…. The Mainstreaming Addiction Treatment Act needs to move through Congress.

Enact it already. Introduced in May 2019, this bill underscores the devastation caused by the opioid epidemic. It cites numerous statistics that show the extent of this problem. None is more compelling than the dramatic number of those who have perished from addiction. In 2017 alone, 70,237 people died from overdoses. Another fact? Only one in five of those with OUD receive treatment. According to the bill’s sponsor: “The devastation of America’s opioid crisis has touched every part of our country, and access to treatment is a matter of life and death. Our national response needs to rise to meet the unprecedented scale of this crisis.” How?

This legislation opens the way by:

• Removing the requirement for practitioners to apply to the Drug Enforcement Administration (DEA) for a waiver to prescribe buprenorphine to treat OUD
• Mandating the Health and Human Services (HHS) Department to run a national campaign to inform practitioners about this change and encourage them to treat OUD as part of their practice

2: Embrace Telehealth

Make it easier for those struggling with OUD to receive care – not just now, but always. What does this mean? As COVID-19 raged, several federal agencies issued interim waivers. The recommendation: make them permanent. Let’s take the case of the Substance Abuse and Mental Health Services Administration (SAMHSA). It took action on this front by enabling those on daily dosing for methadone and other meds to receive two-week supplies. The DEA acted similarly. Its Diversion Control Division also lifted a requirement. Persons in treatment no longer have to see health care providers in person; they may connect via phone or video call. And the Centers for Medicare & Medicaid Services is covering these services.

These face-to-face provisions have proved problematic at all times; the pandemic made it worse. The author of this piece explains. “Even before the coronavirus, the requirement for in-person visits often created challenges for people with OUD, who may have had difficulty finding transportation or needed to prioritize work or family obligations over an in-person visit. If the relaxed rules remain in place, patients will be able to more easily get the care they need even after the global threat subsides.”

3: Meet Patients Where They Are  

Take treatment to the people. That is, fast track regulations on bringing care directly into communities rather than the other way around. This idea targets expediting traveling narcotic treatment programs (NTPs); these are known as “mobile vans.” This initiative helps those with OUD in rural as well as underserved urban areas.

However, new NTPs are at a standstill, tied up in a moratorium and web of regulations and approvals. In February, the DEA proposed rules that would breathe new life into this approach. The suggestion is for the DEA to act – finalize rules to jumpstart activity. If necessary, enact part of parts of the provisions. At any time, but especially now, it would expand access for much needed care. COVID-19 or no COVID-19: end the ban on the van.