ICYMI: Dr. Gupta USA Today Op-Ed on Removal of the X-Waiver

Dr. Gupta: “President Biden called for making access to medication treatment for substance use disorder universal by 2025. By signing [the bipartisan omnibus] bill, he has continued his record of breaking down barriers to treatment and took a historic step to mainstreaming addiction care.”

USA TODAY: Opioid addiction is a disease. We cut red tape so doctors can finally treat it effectively.

[Dr. Rahul Gupta, MD, MPH, MBA, 1/23/23]

Almost two decades ago, I rushed to the emergency room because one of my patients had overdosed.

I had met the patient a month before as part of my newly minted primary care practice in Florala, Alabama, a town of 1,800 residents just above the Florida panhandle. He had been receiving pain medications from different physicians for years, and I had diagnosed him with opioid use disorder.

Federal regulations allowed me to prescribe an addictive category of opioids for pain to my patients, but prevented me from treating my patient for his opioid addiction without a special prescribing license (the so-called X-waiver).

So, I had to refer him to a specialist nearly 100 miles away. But he provided for his family of four working at a small business in town on minimum wage, and my referral meant he would need to take time off work and spend money on gas to get there.

My patient never made it to the specialist. Instead, he started buying illicit drugs on the street.

My patient died in my hands that day at the hospital. And this story has played out all across America, time and time again. More than 107,000 Americans died from drug poisoning last year, and more than a million Americans have perished since the opioid epidemic began two decades ago.

These are sons and daughters, teachers and neighbors, co-workers and friends who have been missing at the dinner table or at family gatherings. Tragically, timely treatment was not available to most of them because fewer than 1 out of 10 people who needed treatment in the United States were able to access it.

I wanted to help my patients with opioid use disorder without having to refer them to care hours away. So, I went through the training and certification to receive my X-waiver from the Drug Enforcement Administration. Today, that’s no longer necessary.

Last month, President Joe Biden expanded access to treatment for opioid use disorder to millions of Americans when he signed the bipartisan omnibus government funding bill into law.

As a physician who has treated patients with addiction for more than 20 years, it’s important to note that as we expand treatment and save lives, we are taking decisive actions to end the stigma surrounding addiction in health care.

I’ve seen how pervasive this stigma is in the medical field. For years, many in my profession used the excuse of not having an X-waiver to refuse to treat patients suffering from addiction with lifesaving buprenorphine.

But the bipartisan Mainstreaming Addiction Treatment Act, which was included in the omnibus bill, eliminated the X-waiver. That means any DEA-registered prescriber of controlled substances can now offer buprenorphine treatment to patients with opioid use disorder without additional federal approvals.

In his National Drug Control Strategy, President Biden called for making access to treatment for substance use disorder universal by 2025. By signing this bill, he has continued his record of breaking down barriers to treatment and took a historic step to mainstreaming addiction care.

Now, health care providers across the nation can begin to treat addiction – a disease of the brain – just as they treat diabetes, heart disease and emphysema.

This is a game changer.

I want to thank every member of Congress and the parents, loved ones and advocates who fought for this bill’s passage. I also want to thank the Department of Justice, the Drug Enforcement Administration, the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration for their shared vision and collaboration in promoting this critical policy objective. Their efforts will help save lives.

And I’m calling on them and our nation’s medical providers, patients, pharmaceutical companies and pharmacies to continue this march forward because there’s still so much to do.

To America’s medical providers, now is the time to recognize substance use disorder just like any other disease and join colleagues who are already screening and treating patients for it.

To Americans with opioid use disorder, now is the time to get the treatment you need from your medical provider. Treatment with buprenorphine can begin with telehealth appointments. If you need care – or think you need care – call them up.

To the pharmaceutical companies, suppliers and pharmacies, now is the time to make sure treatment is available, accessible and affordable.

Now is the time to end this crisis, and these actions will help.

As President Biden said after Congress passed the legislation, “This bill is further proof that Republicans and Democrats can come together to deliver for the American people.”

Addiction isn’t a red state problem or a blue state problem – it’s America’s problem, and we all have to work together to solve it.

This moment reminds me of the lives we’ve lost, like my patient who died nearly 20 years ago. Every five minutes we have a chance to save another life. Let’s all make the most of every opportunity we have.

Dr. Gupta is director of the White House Office of Drug Control Policy.

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