Drug use affects people from all walks of life each year, resulting in as many as 585,000 deaths globally in 2017. North America has among the highest drug-related mortality rates in the world, accounting for roughly 1 in 8 drug-related deaths worldwide—the majority attributable to opioids.
In recognition of International Overdose Awareness Day—observed on Aug. 31 to raise awareness for how to prevent drug-related deaths—U.S. policymakers should look at how other countries have successfully addressed opioid use disorder (OUD), including by improving access to evidence-based medications such as buprenorphine and methadone. Taking similar action in the United States can ensure greater availability of treatment and ultimately save lives.
Expanded buprenorphine treatment options
In the 1980s, France experienced a heroin epidemic, with overdose deaths rising 10% each year over that decade. Health care providers were discouraged from treating people with OUD, and clinicians had to satisfy training and licensing requirements before they could prescribe buprenorphine. Treatment was limited to specialized centers that offered counseling but not medication. Recognizing the need for a policy change, French lawmakers in 1995 allowed primary care doctors to prescribe buprenorphine without any special education or licensing.
Almost immediately, access to buprenorphine increased within both specialized addiction treatment centers and office-based settings. Clinicians were able to treat about 65,000 patients per year with buprenorphine, resulting in a 79% decline in overdose deaths over four years. Before 1996, only 15% to 30% of the estimated 150,000 to 200,000 people who misused heroin had access to specialized settings that offered treatment. But by 2006, more than half of the 180,000 people who misused heroin received buprenorphine from either specialized settings or office-based practices.
In the United States, health care providers must undergo training before receiving a waiver from the Drug Enforcement Administration to prescribe buprenorphine for OUD—a hurdle not required for any other prescription drug. This federal rule is an unnecessary obstacle for the nearly 20 million Americans who live in counties where no clinician had obtained the waiver to prescribe the drug as of 2017. To address this disparity, Congress should pass the Mainstreaming Addiction Treatment Act, which would remove training and licensing requirements for prescribers and help ensure that more Americans receive evidence-based OUD treatment.
Less restrictive regulations for methadone
Despite helping more than 380,000 Americans manage their OUD in 2017, methadone is available only at opioid treatment programs (OTPs), federally regulated health care facilities. However, a majority of states have less than one OTP per every 100,000 people, and between 2008 and 2018, the number of OTPs has increased only incrementally, from 1,132 to 1,519.
Meanwhile, other countries have made methadone available through primary care providers for decades, which has led to substantial increases in treatment capacity and physician involvement. For instance, Australia’s treatment capacity grew from 2,000 to 15,000 patients between 1985 and 1995 after lawmakers made methadone more widely available. And in Edinburgh, Scotland, 60% to 80% of people who injected opioids were enrolled to receive methadone in 1998 and 1999, compared to just 15% in the United States at that time.
Today, methadone remains a highly regulated drug in the United States. To help increase access to this critical medication, American policymakers should consider making methadone available in settings beyond OTPs, including mobile methadone vans, which can help bring treatment to people no matter where they live.
Since 1999, drug overdoses in the United States have continued to climb almost every year. It’s time for policymakers to consider making evidence-based medications, which are used around the world and have been proven to reduce overdose deaths and help people achieve recovery, more readily available.
Beth Connolly is project director and Sheri Doyle is an associate manager with Pew’s substance use prevention and treatment initiative.