Six ways the Biden administration intends to curtail drug overdoses
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Biden administration officials recently discussed several initiatives within a multi-pronged, multi-agency collaboration that they said are needed to address the overdose epidemic.
The discussion came on the heels of CDC data that showed more than 100,000 people in the United States died from drug overdoses in a 12-month period that ended in April.
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“This translates to an American perishing from a drug overdose death every 5 minutes,” Rahul Gupta, MD, MPH, MBA, FACP, director of the Office of the National Drug Control Policy, said during a conference call with reporters. “This is unacceptable, and it requires an unprecedented response.”
Harm reduction approaches
One initiative that officials discussed was harm reduction, which involves “meeting individuals with addiction where they are” and tapering them off drugs slowly, Gupta said.
“This is somewhat novel for the federal government,” HHS Secretary Xavier Becerra, JD, said. “We’re not going to let you go once we catch you and save you. We’re going to stay there with you shoulder to shoulder to make sure you continue forward in your efforts to try to rewrite your life.”
An example of this initiative is the CDC and Substance Abuse and Mental Health Services Administration’s Harm Reduction Technical Assistance Program, which HHS said aims to “strengthen the capacity and improve the performance of [syringe services programs] by implementing a national syringe services monitoring and evaluation program.”
According to the Office of National Drug Control Policy, the American Rescue Plan invested “a historic amount” of money — $30 million — to support harm reduction services.
Buprenorphine access
Another initiative that was announced in April is a guideline that expands access to buprenorphine for opioid use disorder.
According to an HHS press release, this guideline exempts eligible physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives from the training, counseling and other ancillary services that are typically required to receive a waiver to treat up to 30 patients with buprenorphine.
Health care professionals who are interested in utilizing the waiver must be licensed under state law, possess a valid Drug Enforcement Administration (DEA) registration and submit a notice of their intent to the Substance Abuse and Mental Health Administration (SAMSHA). Previously, only physicians who met these requirements were allowed to forgo the ancillary training.
“Addiction treatment should be a routine part of health care, and this ... guideline will make access to quality treatment for opioid use disorder more accessible,” Regina LaBelle, JD, then-acting director of the Office of National Drug Control Policy, said in the HHS press release.
Mobile treatment programs
A third initiative, a final rule that will be overseen by the DEA, allows those who are authorized to dispense methadone for opioid use disorder “to add a mobile component to their existing registration,” according to a DEA press release.
Before the rule was finalized, mobile narcotic treatment programs needed to be registered separately, the press release said. This rule particularly helps patients in remote areas or locations with a shortage of authorized providers receive access to methadone, which the DEA said is an evidence-based, medication-assisted treatment for opioid use disorder.
The rule “sends a very important message that we support the use of medication-assisted treatment for opioid use disorder and are using all the tools at our disposal to make treatment options available to anyone in need of them, anywhere in the country,” DEA’s Assistant Administrator for Diversion Control Tim McDermott said in the release.
Take-home treatments
A fourth initiative allows SAMHSA to “extend methadone take-home flexibilities for 1 year effective upon the eventual expiration of the COVID-19 Public Health Emergency,” the administration said in a press release.
The flexibilities may be extended even further, SAMHSA Executive Director Miriam Delphin-Rittmon, PhD, said during the conference call, adding that “data has shown that offering this flexibility has been effective for those in opiate treatment programs.”
The initiative was initially implemented in March 2020 to lower the risk for COVID-19 by lowering the number of interactions between patients with opioid use disorder or addiction and health care providers, SAMHSA said in a press release. It allows opioid treatment programs to dispense 28 days of take-home methadone doses to “stable” patients with opioid use disorder, and up to 14 doses for “less stable” patients, who the treatment program staff believe “can safely handle this level of take-home medication,” according to SAMHSA.
The Biden administration is also considering whether to allow health care providers to prescribe opioid use disorder treatment via telehealth instead of requiring an in-person assessment, according to the Office of the National Drug Control Policy. In addition, the administration is exploring ways to ensure that Medicaid and Medicare reimbursements for these services continue after the COVID-19 public health emergency expires.
Model law
The fifth initiative is a model piece of legislation known as the Model Overdose Mapping and Response Act, which would expand access to naloxone.
Some aspects of the prototype legislation include showing states how they can increase access to, and availability of, emergency opioid antidotes like naloxone; shielding those who provide such antidotes from “unjust prosecution”; and improving awareness of initiatives that teach individuals about the “life-saving potential” of these antidotes, according to a White House press release.
“We certainly hope that state leaders will carefully consider this model law, which can help save lives,” Gupta said during the call.
Educational videos
The sixth initiative consists of four videos the CDC recently released: “Fentanyl Can be Hidden in Drugs,” “Mixing Drugs Can Cause Overdoses,” “Naloxone Saves Lives” and “People in Treatment and Recovery Need Support.” The videos are intended for young adults, the CDC said. Each video was developed with the assistance of individuals who used drugs and peer recovery professionals.
“This critical information can help all of us save a life from overdose and support people who use drugs in treatment and recovery,” Debra Houry, MD, MPH, acting principal deputy director of CDC, said in a White House press release.
‘All hands on deck’
The record high number of drug overdose deaths and devastation caused by the opioid epidemic will not be solved by one agency working alone, Becerra said.
“We need all hands on deck,” he said during the call. “It’s time to stop the stigma and stop the blame. It’s time for real inclusion and solidarity and compassion. It’s time to follow the science and the data about what works, to listen to those struggling with addiction and to get them the help they need, and for all of us to come together to end this epidemic once and for all.”
References
CDC. CDC launches new education campaigns aimed at preventing drug overdose deaths. https://www.cdc.gov/media/releases/2021/p1027-Preventing-Drug-Overdose-Deaths.html. Published Oct. 27, 2021. Accessed Nov. 29, 2021.
DEA. DEA finalizes measures to expand medication-assisted treatment. Published June 28, 2021. Accessed Nov. 29, 2021.
HHS. Harm Reduction. https://www.hhs.gov/overdose-prevention/harm-reduction. Accessed Nov. 29, 2021.
HHS. HHS releases new buprenorphine practice guidelines, expanding access to treatment for opioid use disorder. https://www.hhs.gov/about/news/2021/04/27/hhs-releases-new-buprenorphine-practice-guidelines-expanding-access-to-treatment-for-opioid-use-disorder.html. Accessed Dec. 1, 2021.
Knopf K. Feds focus on naloxone and fentanyl test strips, blame COVID-19 for OD increases. https://onlinelibrary.wiley.com/doi/10.1002/adaw.33269. Published Nov. 19, 2021. Accessed Nov. 29, 2021.
SAMHSA. SAMHSA extends the methadone take-home flexibility for one year while working toward a permanent solution. https://www.samhsa.gov/newsroom/press-announcements/202111181000. Published Nov. 18, 2021. Accessed Nov. 29, 2021.
White House. The Biden-Harris administration’s statement of drug policy priorities for year one. https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf. Accessed Dec. 1, 2021.
White House. White House releases state model law to help make access to naloxone consistent across the country. https://www.whitehouse.gov/ondcp/briefing-room/2021/11/17/white-house-releases-state-model-law-to-help-make-access-to-naloxone-consistent-across-the-country/. Published Nov. 17, 2021. Accessed Nov. 29, 2021.
Perspective
Back to TopRyan Marino, MD
I am glad President Biden and other people in power care about our overdose crisis, and I hope that we will continue to see more action on this critical issue. As we mark yet another grim milestone of record overdose deaths, I would still like to see even more engagement on this topic, and I would hope that people would start asking why what we are currently doing does not seem to be working to change course this problem.
Historically, strategies have primarily targeted supply-side interventions and criminalization of people who use drugs while largely ignoring other aspects of substance use. These kinds of strategies have failed miserably, as evidenced by continued record-breaking overdose deaths.
While the current administration is moving to expand recovery resources and harm reduction policies, there is still much work to be done, and I hope that they will focus more effort and more resources on those aspects. The lifesaving antidote for opioid overdose, naloxone, remains prohibitively expensive for many without a generic option on the market and available by prescription only. Evidence-based medicines for the treatment of opioid use disorder likewise are prohibitively restricted at the federal level, leaving many Americans without access to good, established treatments. I do applaud this administration’s attempt to expand buprenorphine access; however, we need advocacy for definitive legislative action to expand access to both buprenorphine and methadone, which we have known to work incredibly well for decades but remain under archaic laws that prohibit health care professionals from treating opioid use disorder with the most up-to-date and evidence-based medicine.
Policymakers increasingly use the term harm reduction in describing their approaches, and the aforementioned strategies are all examples of harm reduction; however, true harm reduction also means ensuring Americans who are not yet ready for treatment have access to safety as well. It is one thing to “talk the talk,” but it is past time to truly “walk the walk” as well. What we have seen in this “opioid epidemic” is really a mass poisoning due to unsafe drug supply. Other countries have effectively solved similar problems related to drug safety by not only broadening treatment options but reducing criminalization and working to ensure safe use and safe supply.
Any discussion of this topic would be remiss not to address the reasons that people have for using opioids and other substances, and this administration should be applauded for their focus on widespread social issues and attempt to improve life for all Americans.
It is way past time for the U.S. to review what we have been doing and what is not working. We cannot have “more of the same.” With 100,000 people dead from opioid overdose in the past 12 months, opioid antidotes, recovery resources, and public health and safety resources should be readily available. Every single overdose death is entirely preventable and every single one of these deaths is a policy failure.
Assistant professor, departments of emergency medicine and psychiatry
Case Western Reserve University School of Medicine
Perspective
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Joshua J. Lynch, DO, EMT-P, FACEP
Substance use disorder and opioid use disorder require a multi-pronged approach to succeeding in keeping people in recovery. For far too long, treatment of opioid use disorder focused on abstinence approaches, which never had great success.
The White House plan to include emphasis on harm reduction, especially the HHS strategies, is well received.
Health care professionals, first responders, police, emergency medical services personnel need to keep in mind that most of the patients they encounter with opioid use disorder do not want to be addicted. It can be easy for some of those helping these patients to forget that when they see the same name on an intake form or are going back to the same address because of another overdose. Offering these patients help at the onset and then over and over and over again is what needs to happen.
I would be remiss if I did not mention the MATTERS program here at the University at Buffalo. We embrace aggressive measures to provided efficient/effective evaluations of patients in the hospital (ER and inpatient) along with police/EMS/911 call scenes, provide increased access to medication assisted therapy and provide a completely electronic referral process that provides transportation and medication vouchers if needed. We will start expanding MATTERS to other states outside of New York in the next few months.
Perspective
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Ankit Gupta
The Biden administration’s strategy to curbing the opioid epidemic is on the right track. I am especially encouraged by the components of the Biden administration’s strategy that increase access to telemedicine and provide payment parity for offering opioid use disorder treatment through that mechanism.
Telemedicine-based treatment is key to turning the opioid epidemic around, particularly in rural areas, where there are very few providers that can provide adequate treatment.
Historically, society and the government have taken a hard line on people with addiction, expecting these individuals to quit substances “cold turkey.” The federal government allowing harm reduction approaches — those that allow patients to reduce negative consequences of opioid use — is a significant change in the right direction.
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