This commentary is by Brenda Siegel, who was the Democratic nominee for governor in November.
On Thursday, the Drug Enforcement Administration and Substance Abuse and Mental Health Services released guidelines on buprenorphine treatment access triggered by federal legislation, H.R.2617, the Omnibus FY23 spending package that was signed into law by President Joe Biden.
In this piece of legislation is the language from the Mainstreaming Addiction Treatment Act. This is lifesaving for people with opioid use disorder. It removes a herculean barrier that people with opioid use disorder have faced in accessing treatment and that physicians have faced when wanting to provide treatment, called the X-Waiver.
Upon Biden’s signature on the FY23 spending package on Dec. 29, physicians in Vermont and across this country were able to treat their patients with this lifesaving medication. This is the most transformative change in access to medically assisted treatment for opioid use disorder to date.
The Mainstreaming Addiction Treatment Act is a bipartisan solution that eliminates the redundant and outdated requirements that practitioners must apply for a separate waiver through the Drug Enforcement Administration to prescribe buprenorphine, participate in outdated training and be subject to patient caps. Primary care physicians do not need training, caps and a waiver to prescribe an opioid like Oxycontin.
These requirements have meant that our children, neighbors and community members, when they are struggling, can not easily access the medication necessary to save their lives. In Vermont, some people have to make a three-hour round trip every single day to receive treatment, and that treatment comes with major hurdles that are often unattainable. That means if they have children, a job, lack of transportation or a number of other barriers, then they will not be able to get the treatment that they need or are quickly removed from their lifesaving medication when they cannot meet the requirements. This especially impacts people and physicians in rural communities and places with a high volume of opioid use disorder.
The Mainstreaming Addiction Treatment Act gives the decisions about treatment and health care back to the doctor and the patient. It will support more sustained recovery and will make our communities stronger and safer. Most importantly, it will save lives.
In the time that I have been working on this legislation at the federal level, the lives of well over 600 Vermonters have been lost. In the last six years, the lives of over 845 Vermonters have been lost, with us making little progress on increased harm reduction that follows the up to date science and data.
In 2020, Vermont was No. 1 in the country for increase in overdose deaths, and by a lot. In 2021, we saw the most overdose deaths in the history of our state. I know from both my family’s experience and the people I have talked to across the state that families fight sometimes for months or years to find adequate access to treatment for their loved ones. Far too many lives are lost while in that process.
For the many people for whom buprenorphine is the support they need for recovery, this will make that access far and away easier and this will save many of their lives.
According to the DEA, these are the changes that have been implemented and are effective immediately:
● A DATA-Waiver registration is no longer required to treat patients with buprenorphine for opioid use disorder.
● Going forward, all prescriptions for buprenorphine only require a standard DEA registration number. The previously used DATA-Waiver registration numbers are no longer needed for any prescription.
● There are no longer any limits or patient caps on the number of patients a prescriber may treat for opioid use disorder with buprenorphine.
This means that people with opioid use disorder can go to their regular doctor and access lifesaving treatment. This is the most transformative change to access to treatment to date.
This legislation recognizes the up-to-date science that shows clearly the medication helps people to access sustained recovery and does not need additional hurdles or requirements to work. Up until now, those additional hurdles were required by policy in Vermont and across the country.
Our next step on prescribing buprenorphine in Vermont is to eliminate preauthorization from all insurance companies for all forms of buprenorphine. This preauthorization can sometimes take days; lives are lost, it costs staff hours, and is not medically necessary.
This year the Vermont Legislature will look to not allow the law that removes criminal penalties for buprenorphine to sunset. According to a new study from Johns Hopkins University, this law has caused no harm and is a tool for survival — supported by most physicians, treatment specialists, advocates and people with lived experience.
Allowing primary care physicians to prescribe, removing requirements for prior authorization and removing criminal penalties for nonprescribed buprenorphine together puts the survival of people suffering from opioid use disorder front and center.
We must put harm reduction first. That means centering those tools that we know will help people to survive. In 2018, I introduced a four-part plan to heal the overdose crisis. That plan was based on meetings and advocacy of people with lived experience, prosecutors, police and people in the field. It included removing the X-Waiver, which would require the passage of the Medically Assisted Treatment Act. For this plan to succeed, the work that many had already begun needed to move forward.
This policy change marks an important step forward for this disease. There is no magic bullet for healing this crisis, but each way that we make treatment access and survival possible is an important step forward.
I will be working with legislators to reintroduce several pieces of legislation here in Vermont, including a big bill on the overdose crisis that puts harm reduction first; treatment and recovery on demand, including medically assisted treatment on demand; dual diagnosis support; and criminal justice reform.
I want to extend a huge thank you to U.S. Rep. Paul Tonko, D-N.Y., and U.S. Sen. Maggie Hassan, D-N.H., who were both lead sponsors of the Medically Assisted Treatment Act and championed this lifesaving legislation, ensuring that it would be signed on by a strong bipartisan majority.
I also owe a shout-out to U.S. Sen. Peter Welch, who signed on to this bill as a representative when it was a stand lone bill. After meeting with Senate Majority Leader Chuck Schumer with several national partners, I saw firsthand his commitment to this work. He was instrumental in including this legislation in the FY23 Omnibus spending package.
This is one of the most significant spending packages in our time and helps so many. Too often people with substance use disorder are left out of major pieces of legislation, like this one. Thank you for including this important piece of lifesaving legislation.
This real progress was made possible by advocates that I had the pleasure of working with across the country. I did much of this work as a member leader with Rights and Democracy as part of the People’s Action Overdose Crisis Cohort. I worked alongside my ally, Jodi Newell from New Hampshire, and so many others around the country. Additionally, I worked with the Drug Policy Alliance in its harm reduction subgroup.
I want to be clear that the people that deserve the most praise for work like this are lived experience experts, who walk into their own pain every day in order to make change. Whether they, like me, lost a family member, or they suffer from substance use disorder, it is advocates with lived experience who step up and share their stories freely and ensure that others will have access to tools that they did not, that their family members did not. Thank you to everyone who spoke bravely so that others’ lives would be saved. We are not done yet, but this is a huge step in the right direction.
It is long past time for us to center science, data and lived experience experts so that we can save lives and heal our communities. There are real solutions to make our communities safer and stronger. I am so thrilled to see this leap in a long fight for progress. I am looking forward to building on that progress in the upcoming session in Vermont and across the country.
Correction: Jodi Newell’s name was spelled incorrectly in an earlier version of this commentary.
