Included in the Omnibus Bill of 2022 was the Restoring Hope for Mental Health Well Being Act, the Mainstreaming Addiction Treatment Act (MAT Act), and the Medication Access and Training Expansion Act (MATE Act).
The legislation, as passed, does many things but particularly relevant is that it repealed the X-waiver, previously required by the Drug Enforcement Administration (DEA) for health care practitioners to prescribe Schedule III opioid buprenorphine as medication-assisted treatment for substance use disorder.
While the X-waiver is repealed, the legislation now mandates that anyone other than a veterinarian under state law licensed to prescribe controlled substances and/or who holds a DEA license – including physicians, dentists, chiropractors, podiatrists, nurse practitioners, and physician assistants – will be required to complete a one-time eight-hour course on the treatment and management of patients with opioid or other substance use disorders and the safe pharmacological management of pain.
Specifically, the law requires that if a prescriber is licensed to dispense controlled substances in schedule II, III, IV, or V, that provider must undergo the eight-hour training course, effective the first applicable registration/renewal for the practitioner. For physicians, the course is to focus on the “treatment and management of patients with opioid or other substance use disorders, or the safe pharmacological management of dental pain and screening, brief intervention, and referral for appropriate treatment of patients with or at risk of developing opioid or other substance use disorders.”
For practitioners other than physicians, the course must focus on the “treatment and management of patients with opioid or other substance use disorders.”
The course can be presented by a multitude of providers, including the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, and any organization approved or accredited by the Accreditation Council for Continuing Medical Education (ACCME) or the Assistant Secretary for Mental Health and Substance Use. Additionally, the training requirement may be met through a “comprehensive curriculum” in an accredited medical school or residency program, physician assistant school, or school of advanced practice nursing.
The term ‘first applicable registration’ means the first registration or renewal of registration by a qualified practitioner under this section that occurs on or after the date that is 180 days after the date of enactment, which is June 21, 2023.
The law also notes that no qualified practitioner shall be required to complete the training more than once.
Within 90 days of the passage of the law, which is March 27, 2023, the Attorney General shall provide to qualified practitioners a written, electronic notification of the training requirement outlined within the law. Based on how the law reads, providers may only receive one notification of the requirement.
Part of this requirement was met on January 12th with a notice sent to DEA license holders on the removal of the X waiver requirements.
States are free to supplement this requirement with additional training requirements for providers licensed in their state. Currently, 29 states have additional requirements to prescribe buprenorphine.
Reactions
Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy (ONDCP) released a statement, applauding the omnibus bill and the inclusions focused on opioids and education, saying, “Removing the x-waiver, a burdensome and unnecessary requirement for medical providers, is a critical step at a time when fewer than 1 out 10 Americans who need treatment can access it. With this longstanding barrier removed, I urge my fellow healthcare providers to join in treating addiction and substance use disorder which impacts so many Americans. This bill also provides much-needed resources to those on the front lines of this crisis and ensures that our law enforcement officers have the critical tools they need to keep dangerous substances like illicitly manufactured fentanyl off the streets and away from our communities.”
“In this moment, when the United States is suffering tens of thousands of opioid-related drug poisoning deaths every year, the DEA’s top priority is doing everything in our power to save lives,” said DEA Administrator Anne Milgram. “Medication for opioid use disorder helps those who are fighting to overcome substance use disorder by sustaining recovery and preventing overdoses. At DEA, our goal is simple: we want medication for opioid use disorder to be readily and safely available to anyone in the country who needs it. DEA applauds the repeal of the X-Waiver and all it will do to expand access to buprenorphine for those who need it.”
Milgram also sent a letter to DEA license holders that outline certain points of which DEA registrants must be aware, including that a DATA-Waiver registration is no longer required to treat patients with buprenorphine for opioid use disorder and that all prescriptions for buprenorphine only require a standard DEA registration number.
“We commend Congress, and especially the bill’s sponsors and cosponsors, for passing the MATE Act for the sake of our loved ones and communities, and we thank our ambassadors and advocates for the more than 30,000 actions they took to urge the passing of this bill to spare countless other families from living with the pain of loss,” said Gary Mendell, founder and CEO of Shatterproof. “For too long, the lack of training and treatment has created a gap in care, resulting in countless Americans being unable to access evidence-based care for this chronic, treatable disease. The MATE Act normalizes and standardizes addiction care and empowers providers to better address the ongoing addiction crisis.”
Chuck Ingoglia, President & CEO National Council for Mental Health Wellbeing, said, “We need to ensure people with addictions get good effective care when and where they need it. The lack of healthcare providers trained on evidence-based addiction prevention and treatment in the wake of a national crisis is greatly concerning. The recently introduced Medication Access and Training Expansion (MATE) Act is legislation that would alleviate this problem by ensuring prescribers of controlled substances get the education around evidence-based prevention and treatment they need to effectively treat people with addictions.”
“Over the course of the COVID-19 pandemic, the addiction epidemic has continued to rage, devastating families and communities across the country,” said Senator Michael Bennet, co-sponsor of the MATE Act. “This is a crisis that desperately needs our attention. The MATE Act will better equip our health care system to identify, treat, and prevent addiction, as well as improve pain management by educating providers, addressing racial bias, and standardizing training nationwide.”
“As the nation nears the light at the end of the tunnel with COVID-19, we must not forget another public health emergency our country faces—the opioid epidemic. No community is immune from this crisis, which has been exacerbated by stress and isolation caused by the pandemic. Last year, 504 Mainers died from overdoses, a tragic record that exceeded the deaths caused by COVID-19 in 2020,” said Senator Susan Collins, co-sponsor of the MATE Act. “The opioid epidemic requires an all-of-the-above approach, but increased access to evidence-based addiction prevention and treatment is a critical component of supporting those in need and ultimately tackling this crisis. Our bipartisan bill would ensure that all health care professionals who prescribe controlled substances are also equipped with the tools and training they need to prevent, identify, and treat addiction.”
Congressman David Trone, co-sponsor of the MATE Act, noted that “The MATE Act will help ensure that prescribers of DEA-controlled medication have training in how to treat patients with substance use disorder. Increased awareness leads to better outcomes.”
Congresswoman Lori Trahan, co-sponsor of the MATE Act further noted that, “by standardizing training, we can equip medical professionals across our health care system to prevent, identify, treat, and manage patients with opioid and other substance use disorders. The MATE Act is the effective way forward in ensuring that Americans access evidence-based care for this chronic, treatable disease.”
Congressman Buddy Carter, a pharmacist and co-sponsor of the MATE Act also supported the education, saying, “This bill is critical to ensure health care providers are equipped with the training they need to be able to treat substance use disorder. I’m glad to join this bipartisan group in the fight to end the opioid epidemic once and for all.”
Senator Maggie Hassan, a MAT Act sponsor, said, “for too long, federal barriers, which are rooted in stigma, have impacted access to lifesaving opioid use disorder treatment” and that she was “looking forward to joining advocates and law enforcement to underscore the importance of eliminating the outdated X-waiver requirement, which will help get more people on the road to recovery.”
William Haning, MD, DLFAPA, DFASAM, president of the American Society of Addiction Medicine, believes that, “By ensuring registered prescribers of controlled medications are educated about treating and managing patients with substance use disorder, the bipartisan MATE Act will save lives.”
Andrew Rosenberg, JD Senior Advisor for the CME Coalition, noted that the passage of MAT and MATE should help to improve access to needed addiction therapies and shows the importance of continuing medical education to help clinicians better understand the treatment of pain and addiction identification and referrals.
White House Holds Event
On January 24, 2023, the White House hosted an event on removing barriers to addiction treatment, including the removal of the x-waiver. During the event several government officials, including Dr. Gupta, spoke about the legislation, and families provided their personal testimonies. Dr. Gupta also noted the enactment of this into law is the first step but now “we’ve got to ensure that pharmaceutical companies, that distributors, the pharmacies are making treatment available, accessible, and affordable. We’ve got to make sure that providers and patients know that they have more options for treatments.”
During her speech, DEA Administrator Milgram mentioned the 4800 faces that line the walls of the entrance to the DEA who passed due to fentanyl poisoning. She mentioned that those photos help to encourage her and her team at the DEA to “do everything we can to save lives and to prevent any other faces from being placed on our wall,” specifically referencing the removal of the DATA waiver and how “we are not going from 130,000 individuals who can prescribe buprenorphine to 1.8 million Americans who can prescribe it,” covering “every state in the country, rural, suburban, and urban.”
CCO has created a DEA resource center which offers frequently asked questions, fact sheet, a variety of courses, and additional resources to help you meet the MATE ACT DEA Requirements.
For more information click here
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