Should Medical Professionals be Able to Administer Up to 3 Days of Medication for Patients Waiting to Begin Narcotic Treatment? (H.R. 2281)

What is H.R. 2281?

(Updated January 2, 2021)

This bill, known as the Easy Medication Access and Treatment (MAT) for Opioid Addiction Act, would require the Drug Enforcement Administration (DEA) to revise regulations to allow practitioners to administer up to a three-day supply of buprenorphine to individuals at a time for the purpose of relieving acute withdrawal symptoms while the individual awaits arrangements for narcotic treatment. Currently, regulations authorize up to a one-day supply of narcotic drugs for an individual at a time for a total of up to three days as the individuals transition to long-term treatment for opioid addiction.

Buprenorphine is one of the three forms of medication-assisted treatments (MATs) for opioid use disorder (OUD).

Argument in favor

Medication-assisted treatment (MAT) is the most effective treatment for opioid addiction. As such, applicable regulations should support its use as much as possible. Giving medical practitioners the ability to administer three-day MAT supplies for patients waiting to begin opioid addiction treatment is a step in the right direction.

Argument opposed

Although MAT is effective, there remain valid concerns about its advisability as the treatment of choice for individuals struggling with opioid addiction. Until the U.S. medical community is unified in its opinion of MAT, it’s too soon to reconfigure existing regulations to support MAT administration.

Impact

Individuals with opioid use disorder; individuals waiting to begin treatment for opioid addiction; medical professionals; and the Drug Enforcement Administration (DEA).

Cost of H.R. 2281

A Congressional Budget Office (CBO) cost estimate is unavailable.

Additional Info

In-Depth: Sponsoring Rep. Raul Ruiz (D-CA) introduced this bill to facilitate the administration of MAT to patients waiting to begin long-term treatment for opioid use disorder.

Lead Republican cosponsor Rep. Greg Walden (R-OR) expressed support for this bill, along with 11 other pieces of opioid legislation, in the November 2019 issue of The Ripon Forum. He wrote, “These bipartisan bills represent a commitment to continue the all-hands-on-deck approach in the next front of this fight to stem the tide of addiction and save lives in our communities.”

This bill passed the House Committee on Energy and Commerce by voice vote with the support of one cosponsor, Rep. Greg Walden (R-OR).

Of Note: Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. 

Research shows that a combination of medication and therapy can successfully treat substance use disorders and help sustain recovery. It has also been shown to:

• Improve patient survival;
  
• Increase retention in treatment;
• Decrease illicit opiate use and other criminal activity among people with substance use disorders;
• Increase patients’ abilities to gain and maintain employment;
• Improve birth outcomes among pregnant women with substance use disorders; and
• By reducing the potential for a relapse, contribute to lowering patients’ risks of contracting HIV or hepatitis C

MAT is primarily used to treat opioid addiction to substances such as heroin and opioid-containing pain relievers. The medication normalizes brain chemistry, blocks the euphoric effects of alcohol and opioids, relieves physiological cravings, and normalizes body functions without the negative and euphoric effects of the substance used.

Although medication-assisted treatment (MAT) for opioid use disorder (OUD) is thoroughly researched and validated as a highly effective OUD treatment, it continues to face opposition form the public, health professionals, and sometimes patients themselves.

In May 2017, then-Health and Human Services (HHS) Secretary Tom Price said that MAT is “just substituting one opioid for another,” which he characterized as “not moving the dial much” on opioid addiction. Later, Secretary Price’s office released a statement clarifying that he did support MAT and was open to learning more about and implementing all kinds of treatment options for those struggling with addiction. However, the original statement characterized a common opposition to MAT.

In general, two arguments are made in opposition to MAT: first, that certain MATs can be abused in the same way as opioids. Second, that abstinence should always be advocated first and that those who really want to abstain from taking drugs will seek treatment options that don’t involve taking more drugs.

On a practical level, doctors may struggle to decide which form of MAT patients should receive. This is because there’s no established standard for which patients should receive MAT and what those patients should receive.

Media:

• Sponsoring Rep. Raul Ruiz (D-CA) Statement in Support (Video)
  
• Rep. Greg Walden (R-OR) in The Ripon Society (In Favor)
  
• House Energy and Commerce Committee Republicans Press Release
  
• Hep
  
• Substance Abuse and Mental Health Services Administration (SAMHSA) - Medication-Assisted Treatment (MAT)