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Revised Guidelines May Make It Easier To Treat Opioid Addictions


Every day, more than 240 Americans die of drug overdoses. And so the Biden administration released new guidelines this morning that will make it much easier for medical workers to prescribe buprenorphine for patients who are addicted to opioids. But it is not just doctors who are eligible - physician's assistants, nurse practitioners and even some midwives will be able to use the medication, which helps prevent deadly overdoses.

NPR addiction correspondent Brian Mann has been following this one. Good morning, Brian.

BRIAN MANN, BYLINE: Good morning, Noel.

KING: What is the change the Biden administration has announced? How will it work?

MANN: So buprenorphine has this amazing track record, Noel, helping people with opioid addiction. And as you mentioned, this is a moment when overdoses, especially from fentanyl, are exploding. But for years, federal guidelines required doctors to get extra training and jump through all kinds of regulatory hopes to use this medication. Now the Biden administration has eliminated most of those steps. They've cleared the way also for a lot more health care workers to offer buprenorphine. Dr. Rachel Levine is assistant secretary of health.


RACHEL LEVINE: We have made this much easier for physicians, but also other medical practitioners to be able to prescribe medications like buprenorphine.

MANN: Now, the buprenorphine rules aren't eliminated entirely. Medical workers who use these new guidelines will be limited to treating just 30 patients with buprenorphine, and that could be a problem for some doctors. But again, the hurdles here are now much lower.

KING: And the people who can prescribe it, that group has expanded, which is fascinating - physician's assistants, nurse practitioners. Why is that?

MANN: Yeah. I asked Tom Coderre about this. He's acting head of SAMHSA. That's the federal agency that really focuses on mental health and substance abuse. He says buprenorphine is needed, especially in places where right now there just aren't enough doctors to prescribe it.

TOM CODERRE: There's a lack of physicians, too, in a lot of rural areas around the country. And so by expanding to these additional practitioners, we're more likely to be able to expand access to treatment into those rural areas.

MANN: Now, another big test for this change is whether it will help get buprenorphine into Black communities. They've been hit really hard by fentanyl and by overdose deaths over the last year.

KING: You spent a lot of time talking to people who work in addiction treatment. What are they saying about this?

MANN: Well, they really want buprenorphine to be more mainstream, and they do think this change will help. But here's something interesting. I talked with Dr. Keith Humphreys. He's a researcher at Stanford. And he said it's still unclear how many health care workers will get on board. He points to studies that show stigma surrounds people with opioid addiction, and that stigma affects doctors, too.

KEITH HUMPHREYS: For this policy to work as an immediate response to perhaps 90,000 deaths a year, we would have to see a response from medicine. I mean, I think government has done what government can do in terms of facilitation.

MANN: So that'll be another big test for this. The new policy goes into effect this week, and we'll see if average doctors and physician's assistants all over the country embrace this and start offering buprenorphine to their patients.

KING: We have been talking about the opioid epidemic for years. People have been dying for years, and more Americans are dying now. Why?

MANN: Yeah. Before the pandemic hit, you know, law enforcement and public health experts were seeing this synthetic opioid fentanyl turning up in more and more parts of the country, laced into more and more illegal drugs. Fentanyl is just everywhere now, and it's incredibly deadly. So even people who think they're using something else, like heroin or meth or cocaine, you know, they're overdosing on fentanyl. Then, Noel, came COVID-19 and the lockdowns. That disrupted people's lives, disrupted drug treatment programs. So a lot more people are at risk now, and hopefully this buprenorphine will help.

KING: NPR's Brian Mann. Brian, thanks so much for your reporting.

MANN: Thank you, Noel. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Brian Mann
Brian Mann is NPR's first national addiction correspondent. He also covers breaking news in the U.S. and around the world.

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