Treating opioid addiction with Suboxone is easier. Will doctors get on board? : Shots - Health News Federal restrictions seemed to explain why many doctors weren't prescribing medication for opioid addiction. But some caution that removing those rules isn't enough to overcome hesitancy and stigma.

A roadblock to life-saving addiction treatment is gone. Now what?

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For two decades, with overdose deaths on the rise, the federal government limited access to an opioid addiction treatment that's seen as the gold standard. It's a medication called buprenorphine. Clinicians who wanted to prescribe it needed special approval from federal drug agents. But now that requirement is gone. From member station WBUR in Boston, reporter Martha Bebinger looks at the impact.

MARTHA BEBINGER, BYLINE: That tightly controlled medication, buprenorphine, has helped a woman named Kim stay off heroin and avoid an overdose for nearly 20 years. We're only using Kim's first name to prevent discrimination linked to her drug use. Kim uses a brand of buprenorphine called Suboxone, thin strips of film she dissolves under her tongue.

KIM: It's the best thing they could have ever come out with. I don't think I ever even had a desire to use heroin since I've been taking them.

BEBINGER: That's because buprenorphine is an opioid that reduces cravings for heroin or fentanyl. It has much weaker effects than those drugs. Some clinicians worry about using an opioid to treat an addiction to opioids. But study after study shows it helps people stay off the more dangerous drugs, so there's a substantially lower risk of overdose and death.

KIM: I don't get high on Suboxones.


KIM: They just keep me normal.

BEBINGER: But Kim's had a hard time finding a primary care doctor willing to prescribe Suboxone. So she bounces from one treatment program to another. Sometimes her prescriptions lapse, and the cravings return. That's especially scary now, when what's sold on the streets is increasingly the powerful opioid fentanyl.

KIM: I've seen so many people fall out in the last month.

BEBINGER: Fall out as in overdose.

KIM: That stuff is so strong that within a couple minutes, boom.

BEBINGER: Last year, as deaths after an overdose topped 100,000, only about 7% of doctors, nurse practitioners and physician assistants were licensed to prescribe buprenorphine. The extra steps required by the Drug Enforcement Administration were a major obstacle. Prescribers had to take an eight-hour training. They could only treat a limited number of patients and had to keep special records. They were given a DEA registration number starting with X, a letter that many say made them a target for drug enforcement audits. Dr. Bobby Mukkamala is with the American Medical Association.

BOBBY MUKKAMALA: Just the process associated with being able to take care of our patients with substance use disorder made us feel like, boy, this is dangerous stuff. The science doesn't support that. But the rigamarole suggested that.

BEBINGER: The rigamarole is mostly gone. Congress x-ed what became known as the X-waiver in legislation President Biden signed late last year. But Mukkamala says that perception the waiver created that Suboxone was dangerous lingers.

MUKKAMALA: So there is the legacy of elevating this to a level of scrutiny and caution that needs to be sort of walked back. And I think that's going to come from education.

BEBINGER: A new generation of doctors, nurses and physician assistants are coming out of schools that have added addiction care training. For clinicians who've been out of school for a while, there are lots of resources online. The nation's drug czar, Dr. Rahul Gupta, says getting rid of the X-waiver will ultimately save millions of lives.

RAHUL GUPTA: The impact of this will be felt for years to come. It is a true historic change that, frankly, I could only dream of being possible.

BEBINGER: But other addiction experts wonder, was the waiver the actual reason clinicians weren't treating people addicted to opioids or an excuse used to mask disdain for these patients? The truth serum moment is happening in clinics across the country, including one where Kim is a patient. Nurse Jamie Simmons says many patients with a substance use disorder are complicated, like Kim.

JAMIE SIMMONS: Today was your last Suboxone film from the last prescription. OK.

BEBINGER: Simmons spends all her time on a relatively small number of addiction patients at the Greater New Bedford Community Health Center in southern Massachusetts. Simmons cannot prescribe Suboxone herself, but Kim's primary care doctor may be willing to give it a try now that the X-waiver is gone. Simmons warns Kim that her doctor is worried about drug interactions after learning that Kim uses cocaine and Xanax occasionally.

SIMMONS: She is a little hesitant to keep going. But I'm asking her for more time to work with you so that we can try to work together on some of these other things as well.

BEBINGER: So here's Simmons' plan. She'll manage most of Kim's care while helping the doctor get comfortable with offering addiction treatment. Simmons says buprenorphine prescribing has to become more routine.

SIMMONS: Because you wouldn't not treat a diabetic. You wouldn't not treat a patient who is hypertensive. People can't control that they formed an addiction to opiate, alcohol or a benzo.

BEBINGER: But Simmons knows there are clinicians who do not see addiction as a disease like diabetes. Others hesitate because they don't have a nurse like Simmons on staff to manage addiction care. Right now only about a quarter of patients who might benefit are prescribed the medication. Eliminating the X-waiver will increase the number, but it's not clear how much or how fast. For NPR News, I'm Martha Bebinger in Boston.

CHANG: This story comes from NPR's partnership with WBUR and Kaiser Health News.

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