Despite overwhelming research showing that three approved medications to treat opioid use disorder (OUD) are effective, too few of the estimated 1.6 million US residents with the disease can access these medications. In particular, buprenorphine has been shown to reduce mortality and illicit opioid use and increase treatment retention. Yet in 2019, only 18.1% of people with OUD received buprenorphine or one of the other approved drugs. One important reason for the low rate of buprenorphine use is that too few medical professionals prescribe this clinically effective treatment.
The Drug Addiction Treatment Act of 2000 (DATA 2000) established a pathway for doctors to prescribe medications to treat OUD in office settings, albeit one with a number of hoops that clinicians must jump through. Under this law, clinicians must complete training and receive a Drug Enforcement Administration (DEA) license, or “waiver,” before they can prescribe buprenorphine to treat OUD. DATA 2000 also limited the number of patients a clinician can treat concurrently to 30 in the first year and 100 after that. In the last five years, changes to federal law have expanded the waiver to allow advanced practice providers, like nurse practitioners and physician assistants, to prescribe buprenorphine. Changes to the law also allowed more clinicians to concurrently treat 100 patients and increased the maximum patient limit to 275, depending on the treatment setting and the clinician’s credentials.
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This article first appeared on Milbank Memorial Fund.
Alexandra Duncan is a senior officer and Ian Reynolds is a senior manager with The Pew Charitable Trusts’ substance use prevention and treatment initiative. Jared Anderman is director of data analytics at the Deerfield Institute and Bradley D. Stein is director of the National Institutes of Health-funded RAND Opioid Policy Center and a senior physician policy researcher at the RAND Corporation.