Resolution: S-20-28: EXPANDING MEDICATION ASSISTED TREATMENT THROUGH ELIMINATION OF THE X WAIVER

[Valerie Lile]

WHEREAS​, up to 40% of the 2.3 million individuals in the US with an opioid use disorder receive evidence based treatment​¹​; and

WHEREAS​, less than 4% of licensed physicians are approved to prescribe buprenorphine for opioid use disorder​¹​; and

WHEREAS​, 47% of counties (72% of rural counties) nationwide lack a buprenorphine-waivered physician​¹​; and

WHEREAS​, greater than 80% of family physicians report that they regularly treat patients who are addicted to opioids​²​; and

WHEREAS​, limited availability of appointments with DEA X-waivered prescribers is a significant barrier to receiving treatment due to patient caps and lack of qualified prescribers³​, and

WHEREAS​, long-term outpatient buprenorphine treatment is shown to be more cost effective compared to patients with an opioid use disorder receiving no treatment​4​, now, therefore, be it

RESOLVED​, that Student Osteopathic Medical Association (SOMA) advocates for the removal of DATA-2000 and the restrictions it places on outpatient buprenorphine prescriptions; and, be it further

RESOLVED​, that SOMA recommends that the AOA advocates for the removal of DATA-2000 and the restrictions it places on outpatient buprenorphine prescriptions.

Explanatory Statement

Currently, DATA-2000 restricts physicians’ ability to practice by requiring they receive a X-Waiver in order to prescribe buprenorphine. Reversing this law will remove the caps on the number of patients they can treat and will drastically increase accessibility to medication-assisted treatment for individuals suffering from opioid use disorder. Outpatient buprenorphine has been proven as one of the most effective treatments for opioid use disorder, especially in rural settings where other treatment options may be sparse. Given the large percentage of DOs that practice in primary care, our profession is integral in treating those affected by the opioid crisis.

References

1. Beetham, Tamara, et al. “Access to Office-Based Buprenorphine Treatment in Areas With High Rates of Opioid-Related Mortality: An Audit Study.” Annals of Internal Medicine, American College of Physicians, 2 July 2019, annals.org/aim/fullarticle/2735182.
2. DeFlavio, JR, et al. “Analysis of Barriers to Adoption of Buprenorphine Maintenance Therapy by Family Physicians.” Rural and Remote Health, 4 Feb. 2015.
3. Haffajee, Rebecca L., et al. “Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment.” American Journal of Preventive Medicine, 22 Dec. 2017, http://www.ajpmonline.org/article/S0749-3797(18)30074-6/fulltext​.
4. Schackman, Bruce R., et al. “Cost-Effectiveness of Long-Term Outpatient Buprenorphine-Naloxone Treatment for Opioid Dependence in Primary Care.” Journal of General Internal Medicine, Springer-Verlag, June 2012, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358393/.

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Submitted by:

Nicholas Tod, OMS I – Idaho College Of Osteopathic Medicine
David Bassa, OMS II – Idaho College Of Osteopathic Medicine
Nicholas Scapini, OMS II – Idaho College Of Osteopathic Medicine

Action Taken: ​[Leave Blank. Will be Approved by the House of Delegates or NotApproved.]
Date: ​[Leave Blank. Date submitted to National Vice President and the National Office.]
Effective Time Period: Ongoing​

[Edie Waskel<br>Western University COMP]

As the national director who oversaw the birth and formation of the SOMA Overdose Prevention Task Force, I must state this is directly against the work that SOMA has completed. The training surrounding prescribing narcotics/opioids is in place due to the issue that created the opioid crisis in the first place. Opioids could be prescribed with no limitations whatsoever, and we now see the effects of that in our opioid epidemic. The DATA Waiver training was created to give physicians the confidence to prescribe these medications with training in a new climate where prescription opioids are highly regulated. Unless that regulation is uplifted, then the DATA Waiver training is necessary. Our work as OPTF was to include student training in this at no cost to the student; maybe a better alternative would be to make it free to residents/attending physicians as well as a way to reduce the barrier to MAT education?

Respectfully,
Edie Waskel, OMS IV
SOMA Board of Trustees
AOA Student Trustee

[Shaun Antonio<br>BCOM]

As the Chair of SOMA’s Overdose Prevention Task Force, I agree with Edie’s above comments.

I would also like to point to the level of support from multiple national organizations to expand access to X- Waiver training as the solution to low access to MAT, rather than its removal. This includes the PCSS, SAMHSA, COPE, AACOM, and more. The major factor to MAT access is that the majority of physicians do not take the training, and those who do, are not utilizing to prescribing limits set under current guidelines. Increasing the number of physicians taking and using the training would avoid overburdening physicians who already care for 100-250 patients with opioid use disorder, increase access, and not remove protections that could increase improper prescriptions of opioids.

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