With the passage and signing into law of a federal omnibus appropriations bill last week, the requirement that healthcare providers possess a Drug Enforcement Administration (DEA) X-waiver to prescribe buprenorphine to treat opioid use disorder (OUD) has been eliminated. The move is intended to expand access to addiction treatment.
Named for the “x” that accompanies a narcotics prescribing license, DEA X-waivers have been required to prescribe buprenorphine, a Schedule III drug, as treatment for OUD. Applying for an X-waiver required providers to undergo additional training. The X‑waiver requirement had also limited the number of patients providers can treat. It was largely seen as a barrier preventing many practitioners from treating addiction.
Read the White House’s statement on elimination of the X-waiver.
SR 352, a resolution introduced by Sen. Brooks that directs the Joint State Government Commission (JSGC) to study and issue a report on the specific data, calculations, and mechanisms that the Department of Human Services uses to determine the amount of Medical Assistance capitation funding ultimately paid to drug and alcohol addiction treatment providers within the Commonwealth, was adopted by the Senate on Tuesday, 49-0.
SR 352 directs JSGC to issue a report of its findings, along with any statutory or regulatory recommendations, within seven months of the adoption of the resolution.
JSGC serves as the bipartisan and bicameral research agency of the General Assembly. It provides the legislature with a readily available mechanism for conducting interdisciplinary studies.
The complete resolution, which includes a detailed listing of requirements of what JSGC must analyze and report, can be viewed here.
Since as early as the 1960s, harm reductionists have operated mostly underground and in the shadows in the United States. Today, the harm reduction movement is squarely in the middle of the conversation about and visible on the front lines of the work being done to save the lives of those who use drugs. Harm reduction has positioned itself as arguably the most effective immediate solution to saving people from dying due to a drug overdose. And many, including at the highest levels of state and federal government, are taking notice.
Harm reduction, according to the National Harm Reduction Coalition, incorporates a spectrum of strategies that includes safer use of drugs, managed use, abstinence, meeting people who use drugs “where they’re at,” and addressing conditions of use along with the use itself.
Some of those strategies include syringe service programs (SSPs) and fentanyl test strips. And although opponents of harm reduction argue that such strategies enable drug use, according to the Centers for Disease Control and Prevention (CDC), new users of SSPs are five times more likely to enter drug treatment and three times more likely to stop using drugs than individuals who don’t use the programs. The CDC also reports that SSPs help serve as a bridge to other health services, including Hepatitis C and HIV testing and treatment, and vaccination [read full article].
In Pennsylvania, harm reduction strategies have received bipartisan support, albeit limited. Rep. Jim Struzzi (R) introduced HB 1393, which would legalize fentanyl test strips for personal use. Of the harm reduction bills in the legislature, Struzzi’s has advanced the farthest, having passed out of the full House of Representatives in June of this year. The bill currently sits in the Senate Judiciary Committee. A companion bill, SB 845, sponsored by Sen. Tim Kearney (D), has also been introduced.
Sen. Pat Browne (R) introduced SB 926, which would legalize SSPs in Pennsylvania. It was referred to the Senate Judiciary Committee and has yet to be called to a vote.
In Pennsylvania, more than 170 organizations have signed on as supporters of SSPs. RCPA, along with some of its largest addiction treatment provider members, is among those.
In addition to legislative support, harm reduction efforts are receiving funding support. Over the next 18 years, Pennsylvania will receive more than $1 billion from the negotiated settlement between opioid distributors and Johnson & Johnson and states’ attorneys general. The portion of settlement money the legislature controls has been allocated to DDAP, and it intends to use some of those funds for harm reduction initiatives.
Federally, President Biden’s 2022 National Drug Control Strategy calls for expansion of high-impact harm reduction interventions including naloxone, drug test strips, and SSPs. In New York City, two supervised consumption sites, where drug users bring their own drugs to use under the supervision of trained workers in case they overdose, opened last year in New York City. Rhode Island is planning to open at least one as soon as this year. Others, including in California, are in the planning stages.
Still, some of the most basic harm-reduction strategies, including low-barrier buprenorphine — increased access to buprenorphine through patient-centered programs that are easy to access, offer a high quality of care, and eliminate hurdles to access or stay in care — are not widely available in Pennsylvania. This is, in part, because of state and federal regulations, a lack of buprenorphine prescribers, and antiquated philosophies on addiction treatment held by some influential groups, including some in the legislature.
Despite the life-saving potential of harm reduction strategies, not to mention the bridge they often provide to addiction treatment, they remain stigmatized. For addiction treatment providers, the challenge is finding collaborative ways to work with harm reductionists while staying true to their own missions. Doing so ultimately will best serve the individual in need and save lives.
This week, SAMHSA announced the availability of $22.6 million to public and private non-profit entities through its Medication-Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PDOA) grant. Applications are due Friday, April 29. More information about applying for the grant is available on SAMHSA’s website.