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Access to Addiction Treatment in the Omnibus and Implications for Litigation Dollars

December 23, 2022

Guest post by Libby Jones, Project Director, Overdose Prevention Initiative at the Global Health Advocacy Incubator

The solution to the overdose crisis requires real investment from the federal government, through both funding and policy change, to ensure that there is “no wrong door” for people who are overcoming addiction. The $1.7 trillion omnibus spending package passed by Congress on December 23 not only funds the federal government through the end of fiscal year 2023, but also enacts several key policy changes aimed at increasing access to substance use disorder treatment. Today’s omnibus is a step in the right direction.

Medications for opioid use disorder, primarily buprenorphine and methadone, are the most effective tool we have for saving lives and preventing overdoses, but access to these vital medications has long been hampered by outdated federal regulations. The omnibus includes the Mainstreaming Addiction Treatment (MAT) Act, a bill that removes the federal requirement for practitioners to receive a special registration from the DEA to prescribe buprenorphine to treat opioid use disorder. The special registration, known as the x-waiver, has contributed to a scarcity of treatment providers in communities across the U.S. and has exacerbated already existing disparities in addiction treatment. According to the U.S. Department of Health and Human Services, forty percent of American counties did not have a single x-waivered provider in 2018. Long sought after by advocates, the removal of the waiver was first introduced in Congress in 2019 and marks a significant opportunity to expand treatment. At the Overdose Prevention Initiative at the Global Health Advocacy Incubator, we have joined the call for removal of the x-waiver and are grateful to see the MAT Act passed.

While the omnibus bill does not change the criteria to prescribe and administer methadone, the legislation does include key provisions that will ease restrictions patients face around methadone access. The omnibus will make it easier for opioid treatment programs (OTPs) to set up mobile methadone units, a provision that will provide particular relief to rural Americans who have, on average, a 20-minute longer “travel-to-treatment” distance to an OTP compared to those seeking recurring services for different chronic conditions requiring dialysis. With the growing prevalence of fentanyl in the illicit drug supply, any delay in accessing methadone and OTP services can be deadly. The omnibus will also remove the requirement that patients have opioid use disorder for a year before receiving methadone, a critical step in getting Americans initiated to treatment.

To fully address the overdose crisis, we must eliminate the persistent gaps in our addiction treatment. During the COVID-19 pandemic, telehealth has proven an effective tool to bridging those gaps by allowing waivered practitioners to prescribe buprenorphine without an in-person visit. The omnibus will ensure that those telehealth flexibilities stay in place for an additional two years, giving the federal government time to make those flexibilities permanent.

For too long, outdated federal regulations have unnecessarily throttled access of life-saving treatment for Americans across the country suffering from opioid use disorder. By eliminating some of those onerous regulations, the omnibus is an important step forward and a sign that Congress is moving in the right direction on treatment access. As states devise plans and allocate dollars received through the opioid litigation, the relaxing of regulations by Congress and the Administration make access to treatment with methadone and buprenorphine all the more worthy of investment.