January 14, 2021

Following is from Brett Beckerson at the National Council for Behavioral Health:

It’s been a big week for champions of evidence-based care for substance use disorder!

Treating Methamphetamine Use Disorder
Yesterday, the New England Journal of Medicine released a randomized control trial (RCT) study on the use of bupropion and naltrexone for the treatment of methamphetamine use disorder (MUD).

Among the 403 study participants, nearly 14% of those who took the combo presented mostly drug-free urine samples. It’s a modest percentage but still more than five times greater than participants who received a placebo. Those are lives saved! There are currently no medications on the market to treat meth use disorder, which is a difficult addiction to overcome. But the Food and Drug Administration has approved drugs for other substance use disorders, such as naltrexone to treat opioid and alcohol misuse and bupropion, an antidepressant used to treat nicotine addiction. Researchers used these two drugs to test them as a potential combination therapy.

Treating Opioid Use Disorder
Just a few hours ago,  HHS announced new guidelines allowing physicians to more easily prescribe the opioid addiction treatment buprenorphine to patients. The specific details of the announcement can be found here.

In sum, now any physician can prescribe buprenorphine (any formulary) to a person with an opioid use disorder (OUD). The prescribing cap for non-waivered physicians (note: this does not include physician assistants and nurse practitioners) is 30 patients unless they’re in a hospital setting. This is a huge win for access to care and for destigmatizing medications to treat addiction. There will be an advisory group assessing the impact of this change, which will include representatives from DEA.

For background: Congress set out the requirement in a 2000 drug treatment law and has included it in subsequent legislation since, as some regulators insist it helps ensure safe prescribing. But amid a worsening opioid epidemic, physicians and other providers have complained the prescribing restrictions limit access to buprenorphine, which experts have touted as an essential treatment to fight opioid use disorder. Lawmakers such as Sens. Maggie Hassan (D-N.H) and Lisa Murkowski (R-Alaska) introduced legislation in the previous Congress, S. 2074 (116), to roll back the waiver requirement amid an opioid epidemic that is again worsening, winning support from medical groups.