Emerging federal priorities on substance use policy
What is Congress likely to do to address substance misuse policy? That was the question during a fall summit session on the topic.
Regina LaBelle with Georgetown University Law Center said she doubted Congress would accomplish anything new given the legislative body’s recent track record for doing nothing.
“It would be commendable if they were able to get a budget passed,” she said.
Panelist Rob Kent, former general counsel in the White House of National Drug Control Policy in the Biden Administration, agreed. “I’m not optimistic they’ll take up any legislation,” he said. “If they do, it will be in the context of [the next] omnibus spending bill.”
But Congress failing to address substance use isn’t necessarily a bad thing, said panelist Maia Szalavitz, an author and independent journalist.
“When politicians ignore drug policy, people who know what they’re doing can quietly do stuff that works without it getting politicized,” Szalavitz said, referencing the speedy passage of the 1986 Anti-Drug Abuse Act that instituted mandatory minimum sentences for some drug users.
One bill Szalavitz said she’d like to see passed is the Modernizing Opioid Treatment Access Act, which would expand access to methadone. She criticized “the current setup where you are only allowed to prescribe methadone in these highly specialized clinics, which no neighborhood wants.”
Instead, Szalavitz said, doctors should just be allowed “to prescribe what evidence shows works for addiction.”
Telehealth
During the COVID-19 pandemic, the Drug Enforcement Administration allowed doctors to prescribe buprenorphine as a treatment for opioid addiction through telehealth instead of in-person. That rule is set to expire at the end of this year.
“If you take away the ability for prescribers … to initiate through telephonic means, you are going to cut people off from a medicine they’ve been on, or one that they can get on very easily, and they will die because of that, because they’ll use street drugs and that will kill them,” Kent said.
In January 2023, the DEA no longer required prescribers to use an “X waiver” to treat patients with buprenorphine for opioid use disorder, according to Penn Medicine. The agency also removed caps on how many patients a prescriber could treat with the drug.
LaBelle said that while getting rid of the X waiver was important, “it wasn’t the solution” because there are many reasons doctors aren’t prescribing the medication.
“They say in qualitative surveys, ‘We don’t want those people in our waiting rooms,’ even though ‘those people’ are [already] in their waiting rooms,” LaBelle said. “The strategy has to be comprehensive,” she added, noting that journalists should always ask what the follow-up is to legislation addressing substance use.
“Otherwise, you’re just doing a one-off that gets you some good press and doesn’t really make a difference in the end,” LaBelle said.
