Having held the hand of a loved one desperately sick in an emergency room after an overdose, made calls to get people into urgently needed treatment, and navigated insurance barriers, I've learned firsthand that the opioid crisis is more than just a statistic cited in the news nearly every day. As an addiction-policy researcher, I welcome President Trump's announcement that he and acting Health and Human Services Secretary Eric Hargan are declaring the opioid epidemic a public health emergency. Now we need to see this rhetoric followed by meaningful action and funding.
The president announced several ways he will reduce or waive government regulations to expand treatment, but one federal regulatory change that would benefit vulnerable populations needing treatment hasn't yet been discussed. The federal emergency declaration could be used to expand an existing Drug Enforcement Administration waiver to allow jails, prisons, and licensed residential rehab or detox treatment programs to administer methadone and buprenorphine for opioid withdrawal under the same rules as hospitals.
The DEA simply needs to broaden an existing regulation that allows hospitals to dispense methadone and buprenorphine for opioid use disorder without having to get licensed as an opioid treatment program (methadone clinic). Along with extending the hospital waiver to corrections facilities and licensed residential treatment programs, the DEA should remove the "three-day rule" that requires hospitals to make a distinction between whether the opioid addiction diagnosis is secondary or primary to other diseases being treated.
Starting addiction medications in jails and emergency rooms has been shown in multiple studies to improve patient outcomes and reduce overdose deaths. Reducing the strict licensing requirements around the administration of methadone and buprenorphine in corrections facilities will improve health-care delivery to a currently underserved group of patients with a high prevalence of addiction. Tweaking hospital regulations will also make it easier for emergency-room patients to begin buprenorphine treatment right after an overdose, before their withdrawal pain sends them back on the street to use again.
Despite evidence that overdose deaths can be reduced by 50 percent if people receive treatment with the medications buprenorphine and methadone, these treatments are still not readily available. The Spring 2017 report from the President's Commission on the Opioid Crisis recommended that the federal government use its considerable power as a health-care payer to require providers to offer all options for treatment. A draft of the commission's report has weaker language in this regard, but it still strongly supports expanded access to addiction treatment medications and called for the DEA to remove policy barriers.
The FDA commissioner just announced that his agency will even change its labeling, where necessary, to encourage better insurance coverage. Having the DEA offer regulatory relief at the same time will make it even more likely that new treatment protocols are implemented.
Because of the history of stigma around the use of medications for addiction treatment, even with regulatory burdens lifted, some hospitals, treatment programs, and jails may be slow to implement new protocols. Both a carrot and a stick are needed to ensure real change. Provide federal incentives, including both financial and technical support, and then mandate that any health-care or corrections facilities that receive federal funding allow access to all modes of treatment, including all FDA-approved addiction medications. Only then will we begin to see hope for those suffering.