In his first State of the Union address, President Joe Biden outlined his administration’s comprehensive approach to tackling the addiction and overdose crisis that has led to more than 100,000 lives lost over the past year in the United States. Above all, the president called for universal access to three medications to treat opioid use disorder (OUD)—buprenorphine, methadone, and naltrexone—by 2025.
These lifesaving medications, especially buprenorphine and methadone, are considered the gold standard of care for OUD, as they help reduce overdose deaths, illicit opioid use, and infectious disease transmission among people in treatment. Federal laws and regulations, however, often prevent patients from having sufficient access.
Notably, President Biden’s March 1 speech included, for the first time in a State of the Union address, support for harm reduction services, which can help reduce consequences associated with drug use, such as fatal overdose and infectious disease transmission. For too long, federal support for these services has been limited, despite evidence of their effectiveness.
The administration’s plan calls on policymakers to tackle the overdose crisis in complementary ways, including focusing on actions that aim to:
Eliminate barriers to prescribing effective treatment. Federal law requires that all clinicians undergo training and obtain a license before they can prescribe buprenorphine. In part because of these restrictions, 40% of U.S. counties lack any clinician authorized to prescribe the drug. President Biden called for eliminating these requirements, which Congress can do by passing the bipartisan Mainstreaming Addiction Treatment Act. Enacting this legislation could encourage more providers to incorporate OUD care into their practices and help close racial and geographical gaps in buprenorphine availability.
Extend the COVID-19 emergency flexibilities for telehealth and methadone. During the pandemic, federal officials relaxed certain regulations around OUD treatment to help ensure patients could still get safe access to care. Over the past two years, clinicians could initiate buprenorphine treatment for patients without an in-person visit and prescribe OUD medication via telehealth. Patients also were allowed to get extended take-home doses of methadone. These flexibilities kept people in treatment and engaged those who might have otherwise not received care, no matter whether they received buprenorphine or methadone. These regulations should continue as standard practice.
In addition, the administration is working with the National Academy of Medicine to examine federal laws and regulations related to methadone, which is available only in heavily regulated facilities and often out of reach for patients—particularly people in marginalized communities—simply because of where they live or what health insurance they have.
Initiate medications for OUD in nontraditional settings. Meeting people where they are is an effective way of engaging them in treatment as soon as they are ready and can help remove barriers many may face when trying to find and stay in traditional treatment programs. Initiating buprenorphine treatment at both emergency departments and harm reduction programs can reach people who might not be otherwise engaged in the health care system. These lower threshold approaches to OUD treatment can increase the number of people receiving effective medications, including those who are involved in the justice system, experiencing homelessness, or uninsured.
Expand medications in federal corrections settings. Many people who are incarcerated have a substance use disorder, yet only a small number of correctional facilities provide even one FDA-approved medication to treat OUD. Providing such medications to people who are incarcerated reduces risk for overdose when they re-enter the community. Additionally, courts have ruled that interrupting medication treatment during periods of incarceration violates the Americans with Disabilities Act, making availability of medications for OUD in jails and prisons even more urgent. By expanding provision of these therapies in federal corrections settings, the administration can lead the way for states to follow.
Fund syringe services programs, including purchase of necessary supplies such as fentanyl test strips and sterile syringes. Syringe services programs are often the only place that people who use drugs might connect to medical and behavioral health care. But cost, stigma, and policymakers’ misconceptions about these programs and their participants have limited the availability of such services. The administration is calling for federal funding to purchase sterile syringes and fentanyl test strips, which are necessary to provide evidence-based services to people who use drugs. For example, fentanyl test strips can alert people whether their drug supply contains fentanyl, a highly potent synthetic opioid. That information is especially important as polysubstance use has become the main driver of fatal overdose and can occur among people who did not intend to use fentanyl.
Increase access and availability of naloxone. Naloxone is a prescription medication that can reverse an opioid overdose and has been proven to reduce the rate of overdose deaths. The drug can be safely administered by both medical professionals and people who witness an overdose, but associated costs and variation in state laws governing access to it prevent naloxone from getting into the hands of those most likely to need it. The administration plans to examine ways to increase access across the country.
The Biden administration’s approach to increasing access to medications for OUD and harm reduction services can have a significant impact on curbing overdose deaths and helping people with OUD achieve recovery. It’s now up to policymakers to act.
Jenna Bluestein works on The Pew Charitable Trusts’ substance use prevention and treatment initiative.