Waiver Guidelines Limit Medications That Support Recovery

Although recovery advocates have worked hard to make naloxone available and accessible to anyone who is exposed to opioids, it is still easier to get a prescription for an opioid than for MAT.

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Many providers use MAT as part of a larger recovery treatment plan that includes behavioral or group therapy.

Medication-assisted treatment (MAT) is an increasingly important tool for many people with substance use disorder who seek support for their recovery. However, those life-saving medications are capped for the physicians who prescribe them. In order to get additional prescriptions for patients, doctors need to submit a special waiver for the DEA’s approval. If that request is denied, patients in need of recovery support won’t have access to the help they need.

Dr. Anthony Martinez told Here & Now he was about to reach a limit on how many patients he could prescribe Suboxone. He’s allowed to Martinez is with the Erie County Medical Center in Buffalo, New York, and is also an associate professor of medicine at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

“As of today, we have 97 patients currently on therapy, and we have six patients that are waiting, but we’re quickly obviously coming up against that 100-patient cap,” he said. “The initial cap is only 30 patients, so if you’re a new prescriber, in the first year you’re only allowed to treat 30 patients.”

This is in stark contrast to opioid medications, which can be prescribed “off-label” at a doctor’s discretion in extremely high amounts. Although recovery advocates have worked hard to make naloxone available and accessible to anyone who is exposed to opioids, it is still easier to get a prescription for an opioid than for MAT.

“It brings to light the bigger issue, which I think is, why do we have these waiver guidelines to begin with?” Martinez said.

Suboxone and methadone are two medications that are commonly used to treat substance use disorder. They are not new medications: suboxone therapy came into use around the turn of the century. Suboxone is a combination of buprenorphine and naloxone, the same medication that is used to reverse overdoses. When taken appropriately, the medication partially activates the body’s opiate receptors in your body. It prevents cravings long term and can also support someone in withdrawal, which is also known as the acute abstinence period. Many providers use MAT as part of a larger recovery treatment plan that includes behavioral or group therapy.

However, even though the overdose risk for suboxone and methadone is extremely low, the stigma of addiction prevents people from accessing these medications. Martinez said that there were many restrictions in place when suboxone first became available, based on a concern that doctors would incorrectly prescribe it and put patients at risk for overdose and abuse. Those policies haven’t adapted to meet the severe need for them. “But it’s never really evolved, as we have become more and more embedded in this opiate crisis, we still have these caps,” he said.

Doctors don’t want to turn patients away, and understand that a patient who’s asking for help with recovery is in a vulnerable place. The window of opportunity may not stay open for long. Martinez said, “There’s other options for medically assisted therapy, but one of which is methadone. The problem is that there’s very few clinics in our area for methadone, and there’s a long wait list. There’s a medication called Vivitrol, which is an injectable form of naltrexone. But the problem with that is that patients often have to be abstinent from any opiate for anywhere between seven to 14 days. And for a lot of patients, that’s an eternity. It’s a long time to wait. We’ve had some community support in some of the providers that have come forward and willing to utilize spots on their own waivers to help us while we’re in this situation.”

As the drug epidemic continues to claim lives, it’s clear that providers on the front lines are desperate to help. However, when it comes to MAT, their hands are tied.

Martinez said, “There is no cap on the number of patients that we’re allowed to treat with potentially addictive and potentially fatal opiate-based pain medications, yet we’re restricted on the amount of patients that we can treat with a medication that can help this problem with much less addiction and overdose potential. Any opiate-based pain medication, it could be abused … But there’s other medications such as Vivitrol that are available that carry the same risk, and there’s no restriction on that.”

Access is key for helping people recover from substance use disorder. Removing the stigma of addiction is one important step toward connecting people with unlimited access to medical care and support.

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