DEA Pumps the Brakes on Congress’ Move to Increase Access to Addiction Treatment

Jeffrey A. Singer

In the latest episode of “Cops Practicing Medicine,” the Drug Enforcement Administration announced new telehealth guidelines for patients with substance use disorder receiving medication‐​assisted treatment (MAT) with buprenorphine. Last December, Congress passed the Mainstreaming Addiction Treatment (MAT) Act with bipartisan support. The act removed the onerous rules and regulations surrounding the “X waiver” that the DEA required health care practitioners to obtain if they wanted to treat addiction with buprenorphine. These requirements deterred many health care providers from offering medication‐​assisted treatment to patients with addiction. According to one study, 87 percent of people with opioid‐​use disorder go without treatment. By removing these restrictions, lawmakers hope more health care practitioners will begin treating substance use disorder and thus expand access to addiction treatment.

Alas, the cops think they know better how to treat addiction. The new rule requires that any patients initially begun on buprenorphine via telehealth must see the prescribing practitioner in person within 30 days. The rule limits the prescription to a 30‐​day supply. This means if the patient can’t get an office appointment with the provider within 30 days, the buprenorphine treatment abruptly ends. It already averages 26 days to get a new appointment with a primary care provider, so there is no guarantee a new buprenorphine patient can get an appointment within the 30‐​day window. It might be even more difficult in rural or other areas with primary care provider shortages.

The cops continue to stigmatize people with substance use disorder. They fear that patients will use the buprenorphine to get “high” or sell it on the street to other non‐​medical users. But buprenorphine is a weak partial opioid agonist, unpopular among recreational drug users. Studies indicate that most people who buy buprenorphine on the street are self‐​administering medication‐​assisted treatment with buprenorphine because they can’t get appointments for treatment.

The new DEA rule is likely to cause the abrupt cessation of buprenorphine MAT for many patients who just began treatment. Shortened or abrupt cessation of treatment will very likely cause patients to resume non‐​medical use of opioids in the dangerous black market.

The DEA should get out of the way of health care practitioners who want to help Americans seeking help for addiction. The agency has no business dictating how to practice medicine.