Joe Biden Nixes Trump Reform to Boost Opioid Addiction Treatment

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President Joe Biden has reversed a life-saving drug reform made by the Trump administration, two doctors wrote in an op-ed published by the Wall Street Journal on February 8.

A bipartisan group of legislators is now urging Biden to revive Trump’s life-saving reform.

Drs. Brian Barnett, a psychiatrist, and Jeremy Weleff, a resident in psychiatry in Ohio, wrote that “to the astonishment of the medical community,” Biden on January 27 reversed a January 14 change by the Trump administration to allow nearly all physicians to prescribe buprenorphine.

The doctors described the drug buprenorphine as “one of the most effective treatments for opioid addiction,” adding:

Previously, only doctors who had completed an eight-hour training course and obtained a license from the Drug Enforcement Administration could [prescribed buprenorphine]. Only 7% of physicians are certified to prescribe the drug, and more than half of rural counties lacked a single prescriber as of 2018.

President Biden had promised during the campaign to abolish the licensing requirement, known as the “X-waiver,” which President Trump’s Department of Health and Human Services moved to nix a week before he left office. After France eliminated a similar regulation, the number of patients receiving buprenorphine increased tenfold, and opioid overdose deaths dropped by 80% in four years.

The Biden administration argued that the Trump-era change had legal problems, including a failure to receive clearance from the White House budget office.

Barnett and Weleff further opined:

We hope this about-face wasn’t political. But if the only issue is procedural, why not let the change stand until Congress passes legislation to regularize it? There is every reason to do so: Nearly 130 Americans die of opioid overdoses on an average day, and a bipartisan bill has already been proposed, with plans for reintroduction.

In a rare show of bipartisanship, a group of lawmakers is urging Biden to let more doctors prescribe buprenorphine.

“Lawmakers — led by Sens. Maggie Hassan (D-N.H.) and Lisa Murkowski (R-Alaska), who are joined by four members in the House — are reintroducing legislation that would eliminate the rules and urging the president to support the bill,” the Washington Post reported Tuesday.
The lawmakers are reportedly calling on the president to “deliver on your promise to expand access to medication-assisted treatment” in a letter obtained by the Washington Post.

“We respectfully request that you prioritize the elimination of the X-waiver in order to deliver on your promise to expand access to medication-assisted treatment,” the lawmakers wrote.

The Post learned from three administration officials who reportedly spoke on the condition of anonymity that the Biden administration is reviewing options to eliminate the waiver.

Drs. Barnett and Weleff wrote in the Wall Street Journal editorial:

Perhaps the Biden administration will eliminate the X-waiver in its own manner. But how can it justify further delay with overdose deaths increasing amid the pandemic? If the administration lacks the courage to act now, we implore Congress to do so. It should use the next Covid-19 [coronavirus disease] relief package as an opportunity to end the X-waiver’s deadly reign.

The X-waiver originates from U.S. regulators’ concerns about using an opioid — buprenorphine — to treat opioid addiction.

A similar requirement does not encumber doctors prescribing opioids to treat pain, Barnett and Weleff noted.

The doctors acknowledged that treating opioid addiction with an opioid might invite criticism.

However, they added that it makes sense because “buprenorphine’s chemical structure allows it to reduce cravings for other opioids like heroin while decreasing the risk of overdose should patients relapse on them.”

Moreover, buprenorphine does not trigger the intense euphoria of other opioids. It is usually combined with naloxone, “a medication that blocks buprenorphine’s effects if injected, making misuse rare,” Drs. Barnett and Weleff wrote.

The Post pointed out:

Medical groups have hailed buprenorphine as a lifesaving treatment, particularly as the opioid crisis has accelerated during the coronavirus pandemic. The Centers for Disease Control and Prevention reported that more than 81,000 drug overdose deaths occurred in the United States during the 12-month period ending in May 2020, the highest 12-month death count on record.

After rising for 28 years and following a massive death spike under the Obama-Biden administration, the number of overdoses dropped during the pre-coronavirus pandemic Trump-era.

Some doctors credited some of Trump’s policies to combat the opioid crisis, namely “strict border control,” for the drop in lethal overdoses linked to the drug.

Trump warned that coronavirus-related lockdowns, largely backed by Democrats, would fuel a spike in overdoses and derail the fragile progress his administration made combatting the crisis, one of the former president’s top priorities.



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