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Congressman Lloyd Doggett

Representing the 35th District of Texas

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KSAT: Federal bill would make live-saving opioid addiction treatment easier to prescribe

June 23, 2019

SAN ANTONIO - A drug experts say is saving the lives of opioid addicts is barely being prescribed in Texas.

That's because doctors need hours of extra training and a government waiver just to write a prescription for buprenorphine.

A new federal bill just filed aims to cut that red tape and give doctors leeway.

But time is of the essence as overdose deaths continue to skyrocket. So in the meantime, UT Health San Antonio psychiatry professor Dr. Jennifer Potter is making San Antonio ground zero in the effort to get doctors trained.

Potter is leading a massive statewide training program so more medical professionals can start prescribing now.

"Last year, we had over 42,000 opioid-related overdose deaths in the United States. That's more than at the height of the HIV epidemic," she said.

Buprenorphine is in the same drug class as methodone but can be taken daily at home in a pill or dissolving tablet form. There is also an injection available, but Potter said it is much more expensive.

"Buprenorphine reduces the the risk of overdose death by 50%," Potter said.

The drug can be prescribed by a specialist or family doctor, but they have to have a waiver from the Drug Enforcement Agency.

"If a medical provider gets training, they are allowed to apply for what's called a DEA X waiver. That X waiver requires them to take additional training over and above their medical training in order to prescribe this medication," Potter explained.

Training for doctors is eight hours. For nurse practitioners and physician assistants, it's 24 hours.

Potter said waiver supporters want doctors to have the extra training. However, many call it a barrier.

"I absolutely believe that we should all provide high-quality education to health care providers about treating addiction. Having said that, when a regulation becomes a barrier to saving lives and that risk/benefit ratio is just not there, it doesn't make sense. Yes we need training, but X-ing the X waiver will save lives," Potter said.

X the X Waiver is a national campaign that has attracted so much attention, a bipartisan group of federal legislators recently filed a bill, supported by Rep. Lloyd Doggett.

"We're asking Congress to pass legislation that would say you can prescribe buprenorphine just like you can prescribe any other drug," said Bexar County Opioid Taskforce Chairman T.J. Mayes.

Potter joins Mayes on the task force, which as a whole has been fighting to scrap the waiver so buprenorphine is more readily available.

"The waiver requirement was put into law in 2000 when there was a lot less certainty about the efficacy of different drugs. Study after study shows that these drugs are effective and safe and will help them get rid of their addiction to opioids," Mayes said.

Mayes said the political support looks promising, but Potter isn't willing to wait while overdose numbers continue to rise.

The Centers for Disease Control and Prevention has even given her emergency funding to train doctors so they can get waivers.

It's estimated fewer than 1,500 health care providers in Texas have waivers to prescribe buprenorphine.

In just a few sessions, Potter has trained an additional 230 people. That number will rise significantly this summer when she leads a training road trip across Texas.

"We're going to 30 communities. We're going to Beaumont, we've got to hit Houston and then we're going down the coast. These are large and small. We're in Pecos, Texas, next week. I think we have one person registered, but we are going there to train that person because having that provider available in Pecos, Texas, is pretty important.

Every doctor who gets a waiver becomes part of a statewide network with monthly video and phone conference calls so they can ask questions and learn from each other.

It's a proactive way to spread awareness through the medical community while legislators work to change laws.

"To look in the face of someone struggling with addiction and not be able to provide them treatment is difficult because recovery is possible, and when you see a life transformed by a life-saving medication for opioid use disorder, it is inspirational," Potter said.

The House bill filed is called the Mainstreaming Addiction Treatment Act (HR 2482).

Along with scrapping the waiver requirement, it would also mandate the launch of a national campaign educating clinicians about changes and encouraging more addiction treatment options, like buprenorphine.

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