Good day everyone!  It’s been a minute since we incorporated an AATOD update in our newsletter and this one is a doozy.

There is a lot going on in our industry at the federal level. From the NASEM two-day meeting organized to look at the SAMHSA federal regulations, to multiple bills introduced into the United States House of Representatives and Senate. We also have an upcoming national conference that will be in person, so let’s dive in.

First, the NASEM workshop titled “Methadone Treatment for Opioid Use Disorder: Examining Federal Regulations and Laws” included many individuals who shared either their lived experience or academic experience in our field. Interestingly, it seemed to lack testimonies from persons who have worked in the field with some notable exceptions including Dr. Kenneth Stoller and Mark Parrino. The information resulting from the two-day workshop is too extensive to share here, so I encourage you to read this article in ATForum by Alison Knopf: https://www.atforum.com/2022/03/nasem-methadone-expand-access-primary-care/ You can also go to this website to watch the recordings of all the workshops: https://www.nationalacademies.org/event/03-03-2022/methadone-treatment-for-opioid-use-disorder-examining-federal-regulations-and-laws-a-workshop

On May 15th, I headed to Washington DC (virtually) and completed four meetings with legislative staff.  I met with Legislative Assistants in Senators Warnock and Ossoff’s offices, as well as Representatives Austin Scott and Buddy Carter.  John Haigler, the OTPG Treasurer, joined me for the meeting with Representative Carter’s staff since he is a constituent in that district.  This meeting was important because Mr. Carter is a sitting member of the Energy and Commerce Committee, the committee with jurisdiction over one of the bills.  So, let’s take a look at the proposed federal legislation that may impact our field.  The first is HR 6279 & S. 3629 Opioid Treatment Access Act (Cong. Norcross, D-NJ; Sen. Markey, D-MA). There are components of this bill that AATOD supports, such as sections two and three that direct SAMHSA to study the impact of the COVID-19 methadone take-home exemptions, allows for OTPs to operate mobile components without a separate DEA registration, and also directs SAMHSA to study and revise the timeline for patients to receive take-home doses of methadone.  These sections could improve access to treatment for patients and provide valuable information to the field and others. While those sections are good, section four of the bill needs to be re-written because the current version would allow addiction board certified practitioners to prescribe one-month of take-home methadone doses to be dispensed from a community pharmacy without regulations or oversight.  The current version would allow for indication of new patients to occur at home, and as we all know, the most crucial time during induction is days three through ten, and methadone diversion and inadvertent overdose deaths could increase exponentially if unstable patients were given monthly supplies of methadone through community pharmacies.  AATOD’s position is that this type of medical maintenance model could be valuable to stable patients, so the current language should be revised to say that prescribing should only be permitted for OTP physicians treating patients enrolled in the OTP who meet the SAMHSA definition of stable.  The second bill is HR 1384 & S 445 Mainstreaming Addiction Treatment (MAT) Act (Cong. Tonko, D-NY; Sen. Hassan, D-NH).  This bill proposes to eliminate the DEA X-Waiver program across the board, which results in removing all prescriber education requirements, the limits on number of patients treated by prescribers, patient drug screening and counseling referral requirements, and the data collection currently conducted by SAMHSA.  Proponents of the bill argue that any physician can prescribe opioids without oversight, but as we all know, this is a large contributing factor to the current opioid epidemic.  Proponents also say this will increase access to treatment, but the real numbers show this is not necessary.  Currently, 6,141,185 Americans can be served by Certified Buprenorphine Providers [1], and in the 2019 National Survey on Drug Use and Health, 1,600,000 Americans had an opioid use disorder in the past year.  Capacity exists to treat these patients, were all Certified Providers operating at their allotted capacities.   AATOD supports increasing access to treatment for patients by: removing infrastructure and technology barriers to telehealth in rural areas; considering increase in take home allowances from highly structured, highly regulated Opiate Treatment Programs (OTP’s) for eligible, stable patients to reduce transportation time and costs; supporting initiatives to use medication units and mobile vans operated by highly regulated OTP’s and for which DEA has current guidelines; and supporting removal of Prior Authorization requirements for treatment entry, for all insurance types, expanding on CARA 3.0’s proposal on this matter. The final bill in consideration has only been introduced into the House and is HR 2067 Medication Access and Training Expansion (MATE) Act (Cong. Trahan, D-MA).  AATOD fully supports this legislation as it proposes to increase access to education and funding grant programs for education of buprenorphine prescribers. Education requirements and opportunities for prescribers is key since only 8% of American Medical Schools offer education on Addiction.[2]

Finally, the good news!  AATOD will be having an in-person conference in Baltimore, October 30th through November 3rd of 2022.  I’m so excited that we will all have the opportunity to learn and see each other in person again at this fabulous event.  Visit https://www.eventscribe.net/2022/AATOD/ to register for the conference and book your hotel.

Stacey Pearce, AATOD Delegate

[1] https://www.samhsa.gov/medication-assisted-treatment/practitioner-resources/DATA-program-data, updated daily, March 19, 2021.
[2] Hoffman, Jane. “Most Doctors are Ill-Equipped to Deal with the Opioid Epidemic: Few Medical Schools Teach Addiction.” New York Times (New York) 10, September, 2018.