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The US Drug Enforcement Administration will allow more healthcare professionals to prescribe a drug to treat opioid addiction. The change, announced on Tuesday, opens up access in rural America where there are few doctors.
A law passed in 2016 added categories of practitioners who may prescribe bupremorphone, a narcotic drug, for maintenance or detoxification treatment. Before 2000, only doctors can treat opioid addiction patients and the physicians had to register with the DEA as a doctor and the operator of narcotic treatment programs, Reuters reported.
To benefit rural counties
The change is expected to benefit rural counties which a 2017 study, published by the National Rural Health Association, discovered that 53 percent of rural counties had no doctors that can prescribe medication for opioid addicts. As a result, the treatment is not available to 30 million people who live in rural areas since 90 percent of doctors allowed to prescribe bupremorphone live in urban counties.
With the new DEA policy, about 5,000 mid-level practitioners can now prescribe it. Another 43,000 health practitioners may qualify to prescribe the opioid addiction medication.
Another 2017 study by the US Centers for Disease Control and Prevention found that there are more drug overdose cases in rural areas than in urban centers. In 2016, opioids caused the death of more than 26,000 people, making drug abuse a leading cause of mortality. The CDC said it is a record-high death toll of any year.
David Fiellin, a professor of medicine, emergency medicine, and public health at the Yale School of Medicine, said the DEA action reflects the work and the ongoing need to further expand the access to the most effective treatment for opioid use disorder.
No induced withdrawal
According to Reason, bupremorphone is designed to wean opioid addicts off prescription painkillers and heroin without inducing withdrawal. The new policy allows care providers to register as administrators of narcotics treatment programs and to prescribe the medication in outpatient settings.
Nurse practitioners will also be permitted to administer the drug without a doctor on the premises if the state allows it. When the FDA approved bupremorphone in 2002, the same year, the Department of Health and Human Services created a waiver program.
The waiver program was designed to make available an alternative to regulatory obstacles that doctors must go through to establish a treatment center. The application is submitted to both the DEA and the FDA and a state regulatory agency. The three agencies will then interview and inspect the facilities.
With the Comprehensive Addiction and Recovery Act passed in 2016, the language of the waiver program was changed to qualifying practitioner from qualifying physician. The definition includes doctors, physician assistants, and nurse practitioners. But that will be until October 2021; beyond that period, the language will have to be re-authorized.
The new policy allows a licensed nurse practitioner or physician’s assistant to administer a schedule III drug and apply for a waiver. The schedule III drugs have moderate potential for abuse and can be mildly habit-forming.
The irony is that many states that are hardest hit by the opioid epidemic, such as Pennsylvania, New Hampshire, Kentucky, West Virginia, and Ohio, suffered from the highest overdose rates in 2016, but disallows nurse practitioners from administering a schedule III drug, except for New Hampshire.
Another 2016 survey discovered that 36 percent of waivered doctors are not treating the maximum number of patients allowed by the Department because of lack of time to treat more patients. Nurse practitioners can actually manage 80 percent to 90 percent of the care provided by primary care physicians, a 2015 review by the Kaiser Family Foundation found. The study said that the primary care outcomes between doctors and nurse practitioners are almost identical.
Supervised drug injection sites
Meanwhile, to battle the opioid epidemic gripping the nation, Philadelphia wants to be the first US city to permit supervised drug injection sites, city officials said on Tuesday, Time reported. The city authorities are in search of an outside operator to put up one or more supervised injection sites in the city.
Dr. Thomas Farley, the Pennsylvania public health commissioner, said that the sites could be a life-saving strategy and a pathway to treatment. It will be one part of the city’s overall plans to fight the opioid epidemic. He stressed, however, that by opening a supervised drug injection site, it is a condonation or support for illegal drug use in any way. All that the city wants is to get help for residents saddled with drug addiction.
Vancouver in Canada has such a site, while in 2016, France opened the Supervised Drug Inspection Site which was expected to serve up to 200 opioid addicts every day, The site, expected to cost the French government $1.3 million a year, is part of a national effort to address the spread of infection and overdosing among opioid addicts, The Atlantic reported.
[메디컬리포트=Vittorio Hernandez 기자]