Last year, over 107,000 people died of a drug overdose, setting a grim new record in the decades-long epidemic. Further, new data from the CDC shows that Black and American Indian or Alaska Native people are dying at significantly increasing and disproportionate rates compared to their white counterparts. As more families and communities across the country are devastated by this crisis, there is an urgent need for widespread implementation of equitable, effective public health practices to save countless lives.
The good news is that policymakers from Philadelphia to San Diego are ramping up effective public health strategies, including increasing the use of harm reduction practices and expanding access to substance use disorder treatment services and medications.
Yet more can be done to halt this epidemic. There are key federal opportunities that Congress and the Biden administration must take immediately.
Establish telehealth as a permanent option
As in other areas of healthcare, telehealth options for admitting, diagnosing, and medicating individuals with opioid addiction have increased rates of treatment entry and retention. Federal agencies, including the Department of Health and Human Services (HHS) and the Drug Enforcement Administration (DEA), should work with Congress to make permanent federal telehealth flexibilities that allow people to access needed addiction services and medications.
COVID-19 has shown us clearly that virtual modalities of care delivery can work on a large scale. As emergency waivers put in place during the pandemic approach expiration, this administration must extend and make permanent for opioid addiction the same telehealth policies currently available in the rest of healthcare. Specifically, this policy should allow: audio-only telephone calls when audio-visual technology is unavailable; the ability to prescribe buprenorphine via telehealth without an initial in-person visit; and the ability to increase take-home doses for patients in Opioid Treatment Programs.
The Centers for Medicare and Medicaid Services (CMS) recently proposed to permanently allow Medicare beneficiaries to initiate buprenorphine treatment via telehealth — but this sensible initiative has yet to be authorized by the rest of HHS or the DEA.
For individuals who live far from treatment providers, those with limited access to transportation, those whose ability to take time off work is extremely limited, and for those who are primary caretakers of children, elderly individuals, and/or others with disabilities, telehealth options can drastically expand equitable access to care while maintaining protection from inappropriate usage.
Pass the Medicaid Reentry Act
Twice passed by the House of Representatives, this bipartisan legislation would permit Medicaid to support essential healthcare for 30 days prior to individuals’ release from incarceration and upon their reentry.
Data show that in the first two weeks of reentry, people leaving incarceration are 129 percent more likely to die from a drug overdose compared to the general population. Enabling more coordinated care for people who are in carceral settings and returning to our shared communities would reduce overall healthcare costs by decreasing use of emergency departments and hospitalizations, and it should also significantly reduce mortality rates.
Ensuring Medicaid coverage for people in this vulnerable period should enable rapid admission to and engagement with community-based addiction treatment providers.
Over the past few years, a dozen states have applied to CMS for Medicaid Reentry waivers. In addition to Congress passing the Medicaid Reentry Act, CMS should quickly issue overdue SUPPORT Act guidance to states and approve all pending waivers.
Ensure adequate coverage in Medicare
While an estimated 1.7 million Medicare beneficiaries are living with a diagnosed substance use disorder, a staggering 93 percent of those beneficiaries aged 65 and older do not receive addiction treatment.
A significant reason for this is the lack of insurance coverage for addiction care. As currently structured, Medicare does not cover the full continuum of treatment services recognized by the American Society of Addiction Medicine, nor the range of providers and settings needed for effective, evidence-based treatment.
Neither is Medicare subject to the Mental Health Parity and Addiction Equity Act, meaning individuals who rely on Medicare are not protected from insurance discrimination related to addiction and mental health coverage in the same way those who have Medicaid or private insurance are.
Modernizing Medicare is essential to ensuring its beneficiaries, who account for nearly one fifth of the country’s population, can access the comprehensive care they need and not experience treatment disruptions when they first become Medicare-eligible.
Eliminate the X waiver
Buprenorphine is a highly effective opioid use disorder medication. However, outdated and onerous regulatory requirements — such as the requirement that physicians obtain a special, or “X”, waiver to prescribe buprenorphine — significantly restrict access to this lifesaving medication. Data show that only one out of nine people who would benefit from this medication actually receive it. Further, there is a pronounced racial disparity in access with Black patients being 35 percent less likely than white patients to receive it.
The Mainstreaming Addiction Treatment (MAT) Act is bipartisan federal legislation to eliminate the X waiver requirement that was recently approved by an overwhelming 402 to 20 vote in the House. The Senate should quickly approve the MAT Act, so that it can be signed into law. Passage of the MAT Act is one key piece of expanding equitable access to effective substance use disorder medications.
To make meaningful progress, policymakers must also employ additional strategies to engage the medical community more effectively in providing evidence-based addiction care.
These four initiatives hold enormous potential to not only help our nation combat the overdose crisis, but to build greater health equity overall.
With the CDC’s recent report showing the increasing racial disparity in fatal overdose, it is more pressing than ever that Congress and the administration take all necessary steps to ensure ALL those in need of care can access and afford lifesaving treatment.
Tom McLellan is the former deputy director of the White House Office on National Drug Control Policy and founder of the Treatment Research Institute. Paul Samuels is the president and director of the Legal Action Center. Marcia Lee Taylor is the chief external and government relations officer at the Partnership to End Addiction and previously served as the senior advisor for drug policy and research for the Senate Judiciary Subcommittee on Crime and Drugs.