US eases prescription requirements for opioid treatment

US loosens restrictions on buprenorphine, a drug that helps with opioid cravings, amid record overdose deaths.

Packets of buprenorphine, a drug which controls heroin and opioid cravings, is shown in 2018 [File: Elise Amendola/AP Photo]
Packets of buprenorphine, a drug which controls heroin and opioid cravings, is shown in 2018 [File: Elise Amendola/AP Photo]

The US Department of Health and Human Services has announced new rules easing the prescription of a medication that helps those suffering from opioid addiction.

The guidelines announced on Tuesday mean doctors and other health workers will no longer need extra hours of training to prescribe buprenorphine, a gold standard medicine that helps with cravings. And they no longer have to refer patients to counselling services.

Acting Director of the Office of National Drug Control Policy Regina LaBelle told a press briefing the US is seeing a record number of overdose deaths with the “majority of those who died this year so far from an overdose involving opioids, mainly illicitly-manufactured fentanyl”.

US drug overdose deaths have climbed during the coronavirus pandemic. The Centers for Disease Control and Prevention reported 90,000 drug overdose deaths in the 12 months ending in September, the highest number ever recorded in a single year. There is not yet data for all of 2020, and the figures are preliminary.

Jon Combes holds his bottle of buprenorphine, a medicine that prevents withdrawal sickness in people trying to stop using opiates, as he prepares to take a dose in a clinic in Olympia, Washington, in November 2019 [File: Ted S Warren/AP Photo]
LaBelle, appointed to her position by President Joe Biden in January, said “removing barriers to quality treatment is a top policy priority for this administration”.

Under the loosened guidelines, prescribers will be able to treat up to 30 patients at a time with the drug. It comes in a pill or film that dissolves under the tongue. It costs about $100 a month. A common version of buprenorphine is Suboxone.

Stricter requirements will remain for prescribers who want to treat more than 30 patients at a time.

Because of how opioids act on the brain, people dependent on them get sick if they stop using. Withdrawal can feel like a bad flu with cramping, sweating, anxiety and sleeplessness. Cravings for the drug can be so intense that relapse is common.

Buprenorphine helps by moving a patient from powerful painkillers or an illicit opioid like heroin to a regular dose of a legal opioid-based medication.

Besides doctors, nurse practitioners, physician assistants, certified nurse midwives and some other types of nurses will be able to prescribe buprenorphine without first getting special training.

The Trump administration tried to make a similar change in its final days but it would have applied only to doctors.

The Biden administration put the matter on hold for a legal and policy review, ultimately deciding to expand the easier guidelines to more prescribers.

The prescribing requirements date back to legislation in 2000 meant to prevent too-easy access to medicine with its own potential for misuse. But only a small number of doctors went through the steps and, in many parts of the country, patients could not find a prescriber. Ironically, doctors could prescribe buprenorphine for pain without the extra training.

Source: Al Jazeera and news agencies

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