The Mainstreaming Addiction Treatment Act of 2021, also called the MAT Act, was created to make it easier for healthcare providers to offer addiction treatment for those suffering from an opioid disorder. Before this act, practitioners had to get a special waiver from the Drug Enforcement Administration (DEA) to prescribe certain medications, like buprenorphine (suboxone), for treating substance use disorders.
However, the MAT Act removes this requirement, allowing practitioners to provide these medications for maintenance or detoxification treatment without the extra paperwork. This newly passed bill is a step in the right direction for the opioid epidemic, but it comes with its own set of challenges, such as funding, accessibility, and determining success rate.
Impact of the MAT Act on the Addiction Treatment Space
Controlled substances are categorized into five categories or schedules. Schedule I medications have the highest abuse potential, while Schedule V are low abuse rates. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), all healthcare providers who have a current DEA registration that includes Schedule III authority may now prescribe buprenorphine for Opioid Use Disorder.
By definition, Schedule III identifies as medications that may lead to moderate or low physical dependence or high psychological dependence, which is important to note. Schedule III medications can be difficult to access, especially when time is crucial, and withdrawal symptoms are kicking in.
According to a recent study, 87% of people with opioid-use disorders go without treatment, and before the MAT Act, only 7% of providers across the nation were cleared to prescribe buprenorphine. Removing the waiver or the NOI (notice of intent) increases patient access to medication-assisted treatment.
Finding Buprenorphine: A Guide to Accessing Medication for Addiction Treatment
- Getting access to buprenorphine can be done in a variety of methods, but the most recommended approach is to consult with your primary care physician. Because addiction treatment requires a comprehensive approach, your PCP may be able to refer you to a licensed therapist to ensure you maximize the benefits of your medication. The MAT Act has made it easier for physicians to prescribe medication to assist in addiction treatment by removing the waiver requirement. However, under the new DEA rulings, physicians are limited to prescribing medication for up to 30 days, and then another in-person visit would be required.
- Inpatient rehab is a very real and effective option for many who struggle with opioid addiction. In fact, it may be the best option for many. When admitted to inpatient rehab, Suboxone can be available for those who need it, but other treatment options are also available. These options may include other medications, daily talk therapy and group therapy, alternative therapies, as well as 24/7 supervision. Rehab programs can be particularly effective in reducing the length of time needed to use suboxone before being weaned off of all drugs completely.
- In case of an urgent need for medication, whether for yourself or a loved one, it may be necessary to visit the emergency room, where an emergency provider can prescribe a maximum of 3 days of medication. At this point, you would still need to follow up with a PCP.
- Schedule a telemedicine appointment. The DEA extended the COVID-19 telemedicine flexibilities for prescribing controlled substances for another six months. This new ruling will expire in November of 2023 but allows patients to access medication through virtual appointments. Those who live in rural areas or find it difficult to make in-person appointments now have the opportunity to make a change in their addiction treatment.
- Insurance or no insurance. Oftentimes, insurance can be a barrier when it comes to health. Fortunately, programs like NiceRx make it possible for cash patients to receive coupons on medications they need, including suboxone. Buying illicit drugs off the street should never be an option because they can be laced with other substances and dangerous additives.
DEA’s New Proposed Ruling Threatens Treatment Access
In March of 2023, the DEA proposed a new ruling that could have a detrimental effect on individuals seeking treatment, despite the significant progress made by the MAT Act. The new ruling requires patients who have received a prescription for buprenorphine via telehealth to see a practitioner in person within 30 days.
The new rule also limits patients to a 30-day supply meaning if they can’t get in to see their healthcare provider within that window, there could be an abrupt halt on treatment. There might be people in rural parts of the US who already have a hard enough time finding a provider to prescribe medical-assisted treatment.
If history repeats, we understand that when it’s challenging for patients to access medication, they may resort to obtaining it through illegal channels or, even worse, experience a relapse into addiction, which further contributes to the stigma surrounding opioid addiction in the United States. There is a lot of pushback as to why a policing agent in the US is allowed to dictate medical policy when opioid overdoses are at an all-time high.
Debunking Concerns of Misuse of Suboxone
The opposing side argues that they fear easier access to medications like suboxone could potentially lead to an influx of people trying to resell the medication on the streets. Another concern is that patients who already suffer from an addiction disorder are likely to misuse the medication.
However, even though buprenorphine is a schedule III narcotic analgesic, it is only a partial agonist. Whereas prescription painkillers like oxycodone, methadone, and hydrocodone are full opioid agonists. An agonist is a chemical substance that stimulates a specific response in the body. In simpler terms, an agonist creates a certain action, and an antagonist blocks certain actions. Full agonist opioids activate the opioid receptors giving the full opioid effect. On the other hand, partial agonists only activate just that, partial so to a much lesser degree. 
Although there is the potential for misuse of buprenorphine, Naloxone is added to decrease the likelihood of diversion and misuse. In fact, a recent study showed that taking buprenorphine reduces the risk of overdose or death by 50%. Yes, the drug itself is an opioid, but it produces weaker effects and reduces cravings for deadlier drugs. It’s worth mentioning that buprenorphine has a ceiling on all effects, which reduces the likelihood of addiction. The pros far outweigh the cons.
Combining medication-assisted therapy with counseling from a licensed physician offers the most effective approach for successful treatment. This approach not only provides patients with the necessary support to avoid developing an addiction to medications like suboxone but also ensures that they are taking the appropriate measures in their treatment journey.
Revolutionizing Addiction Treatment for Opioid Disorders
In conclusion, the Mainstreaming Addiction Treatment Act (MAT Act) has brought positive changes to addiction treatment by removing the requirement for special waivers. While challenges remain in funding, accessibility, and combating negative stigmas around it, the act continues to strive for equal access to medication like suboxone. Inpatient rehab has proven time and time again to be the most effective treatment option. As the opioid crisis grows, so does the range of accessible treatment methods. The overall impact of the MAT Act is a step forward in combating the opioid epidemic and providing effective treatment for those in need, and raising awareness of a dangerous war on drugs.
Sources
https://www.cato.org/blog/dea-pumps-brakes-congress-move-increase-access-addiction-treatment
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2780655
https://www.confidanthealth.com/buprenorphine-suboxone-and-subutex/how-to-get-emergency-suboxone
