Why New Guidelines For Opioid Treatment Are A 'Big Deal'

More medical practitioners are being allowed to prescribe buprenorphine under new guidelines from the Biden administration.

The change means that the drug shown to reduce opioid relapses and overdose deaths can be more widely prescribed.

It comes after a year of overdose deaths spiking across the United States. Early estimates indicate about 90,000 people died of drug overdoses in the 12 months ending in September, higher than has ever been recorded. It's about an increase of 20,000 deaths from the previous 12-month period.

The majority of drug overdose deaths involved opioids.

The new rules allow a larger range of health workers to prescribe buprenorphine, including nurse practitioners, physician assistants and certified nurse midwives. They also eliminate the need for doctors and other health workers to take an eight-hour course to be cleared to prescribe it.

"Some physicians actually don't want to prescribe it because they don't want to go to the extra burden of doing the training," says Dr. Nora Volkow, director of the National Institute on Drug Abuse. "So this will increase the number of people that can be treated. And buprenorphine is probably one of the most effective ways that we have for preventing people from overdosing from all of the opioids that are out there in the black market, which are actually quite dangerous."

Volkow talked with NPR's All Things Considered about how the new guidelines could help people with addiction.

This interview has been edited for length and clarity.

Interview Highlights

I understand there is some stigma attached in the medical community to even treating people who are going through drug use disorders and that there was some stigma, kind of reluctance to use these kinds of medical treatments.

There's an enormous amount of stigmatization towards addiction as well as the treatments that we use to help people that are addicted. As a nation we have criminalized substance use disorders rather than treat them. And this is one of the reasons why many clinicians don't feel it's their responsibility to take care of patients with substance use disorder.

The other issue that we need to address is that the insurances do not necessarily cover for the cost of providing buprenorphine treatment. And as a result of that, clinicians don't prescribe them. If you are not going to get reimbursed or not getting reimbursed at the level that's necessary for them to be profitable, then they don't do it. And so that's another aspect that also has been identified as a roadblock in providing buprenorphine treatment to those that need it.

I have heard the idea of buprenorphine is a drug that's highly diverted and that it can end up off market. What are the concerns about the relaxation of these rules contributing to that problem?

Certainly we have wanted to keep our eyes on the potential of buprenorphine to be diverted. And yes, there are areas where buprenorphine is highly diverted, for example, in Kentucky. But in that research, what it shows is when they basically assess: Why are people diverting or buying buprenorphine from the black market? And the main reason is actually to manage their withdrawal and to manage the craving. And one of the factors why they are reaching out is because it's very cumbersome to get access to a buprenorphine prescription in a legal way.

And it's also going to be important to, of course, observe what are the consequences of these relaxations in the way that we are prescribing. But overall, we feel comfortable based on the knowledge that is available, that most of the instances of diversion have been related to the difficulties of accessing buprenorphine for treatment.

Do you think that the relaxation of this rule will start to change the culture around treatment itself?

I would like to call it a big deal because it is, again, bringing forward the treatment of opioid use disorder as for other diseases. We don't have any other medical condition where you as a doctor are told, "By the way, you can only prescribe these medications if you go through this special training and you get a waiver. And by the way, you can only treat so many patients." We don't have any other medical condition.

We have been dealing with addiction with very different parameters. And that's why I call this a big deal, because it's an opening on changing the way that we are allowing clinicians to practice medicine so that it's more similar to the way that they treat other diseases ... like they treat any other medical condition.

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