Congress: Pass the MAT Act to save lives
I recently sent a letter to the physicians of Congress urging support of the Mainstreaming Addiction Treatment Act (MAT), which supports expansion and removing barriers for medications that treat opioid addiction. As a practicing emergency physician, I have intubated and placed more people on life support who had an opioid overdose than those who had COVID-19.
Tragically, the COVID-19 pandemic has increased drug and alcohol use and exacerbated the crisis of addiction in our country. If there were a single public health policy that should be endorsed to save the lives of people who struggle with addiction, it would be this act.
The MAT Act will alleviate a serious barrier to treatment of patients who have an opioid use disorder — the Drug Enforcement Administration’s “X waiver.” The waiver prevents physicians from prescribing medications for opioid use disorder (MOUD), such as buprenorphine, without completing an eight-hour course, or a 24-hour course for nurse practitioners and physician assistants. I have treated patients with opioid withdrawal who went to three or four different clinics or emergency departments to find someone who can prescribe MOUD. They were the lucky ones. Many parts of the country have absolutely nowhere to go for treatment. There is no precedence in the medical world for requiring eight or 24 hours of education before prescribing a single medication. Can you imagine creating such a barrier to prescribing insulin or a new treatment for COVID-19?
There are countless physicians who do not find value in a mandated eight-hour course to prescribe a single drug. As someone who has taken the time to take the long course, I don’t blame them — medical providers are spending time keeping up with changing coronavirus treatment recommendations. Furthermore, adding “extra” and a “different” medical standard for treating addiction perpetuates stigma for people who suffer and furthers a false divide between medical health and addiction health.
The historic reasons behind the DEA X waiver regulation stems back to the 1914 Harrison Anti Narcotic Act. This was a time when opium addiction was a problem and the act prohibited doctors and pharmacists from prescribing opioids to people who were addicted to them. In 1974, when soldiers were returning from Vietnam with heroin addiction, Congress acted by allowing DEA to approve a special circumstance to using methadone for maintenance and detoxification of people with opioid use disorder. This opened up opioid treatment programs who used methadone under special DEA licensing and regulation. In 2000, as science and medicine progressed in terms of treating addiction with medication, Congress voted again to keep up with the time by passing the Drug Addiction Treatment Act, known as DATA 2000. This allowed providers to prescribe MOUD if they took the eight- to 24-hour course. It is time for Congress to show compassion once again to people with opioid addiction and eliminate the outdated barriers that prevent physicians from prescribing life saving medications.
There are those who will claim that MOUD can be abused or diverted. They are correct. There are many drugs that are abused or diverted from Vicodin, Percocet to Xanax and Suboxone, to name a few. The DEA must continue their important work in preventing illegal activity, but they no longer need to add the X waiver barrier to enforce drug safety.
An overwhelming majority of the house of medicine is behind the MAT Act, with few exceptions. Over 20 organizations, including American Medical Association, the American College of Emergency Physicians, the Society of General Internal Medicine and 22 state public health departments, have submitted letters of support for the MAT Act across the county.
Our nation’s addiction experts clearly state that MOUD save lives. And yet, the DEA X waiver remains the single largest barrier for that mission. The waiver exacerbates stigma, it is outdated and unnecessary. Now, more than ever, we need compassion and action in treating patients with addiction. Please, help save countless American lives and American families and pass the MAT act.
Dr. Roneet Lev is former chief medical officer of the White House Office of National Drug Control Policy. She is board certified in emergency and addiction medicine, and currently practices emergency medicine at Scripps Mercy Hospital in San Diego.