While the news is understandably dominated by Covid- 19 updates, there is an ongoing opioid epidemic still looming in our neighborhoods. In 2019, Massachusetts lost roughly 2,000 people to opioid-related overdoses, averaging 5 people a day.
The official 2020 data are not available yet, but due to increased risk factors related to the pandemic, it is unlikely that overdoses have decreased. While there are many contributing factors to epidemics, access to care is on the top of the list.
Last week, the US Department of Health and Human Services (HHS) announced that it would eliminate the X-waiver requirement for DEA-registered physicians to prescribe buprenorphine, a medication used to treat opioid use disorder. Buprenorphine, more commonly known as Suboxone, is a controlled substance. It has been one of the most highly regulated medications in the country.
X-waivers, prescription limitations, consent forms, and urine drug screens have been the norm in treatment for years. The X-waiver requirement was a lengthy certification process that physicians, nurse practitioners (NPs), and physicians’ assistants (PAs) had to undergo before being able to prescribe this medication. It required physicians to take an 8-hour course and NP/PAs a 24-hour course to qualify.
Addiction specialists have argued the waiver requirement was too restrictive, preventing providers from providing lifesaving medication for a chronic condition. As of 2018, only 5 percent of physicians in this country were authorized to use the X-waiver.
Another positive step in policy change came earlier this month when Gov. Baker signed legislation requiring coverage for telehealth services permanently in behavioral health care, which is often where OUD treatment occurs. This legislation will allow for addiction specialists and behavioral health providers to adjust the current telehealth model that was put together under an emergency/temporary basis last spring.
There is still work to be done. The elimination of the waiver does not apply to NP/PAs, who represent a growing presence in primary care and behavior health services. And there are still restrictions on the physicians who qualify for the exemption. Telehealth services are not always ideal for patients.
Technology can be challenging as it lacks the face-to-face interactions patients with OUD need in order to feel connected and engaged in treatment. That being said, to have such significant advancements in policy in the midst of a pandemic is meaningful and will have a long-lasting impact on the way treatment is provided, even after Covid-19 is no longer dominating the headlines.
Denise Studley, a Dorchester resident, is a nurse practitioner and a nurse care manager specializing in addiction psychiatry at Beth Israel Deaconess Medical Center.