In December of 2022, the United States Congress passed the Mainstreaming Addiction Treatment Act, or MAT Act, which removed the requirement for a special Drug Enforcement Administration (DEA) waiver to prescribe the drug buprenorphine used in the treatment of opioid use disorder (OUD). A summary of the bill states:

A community health aide or community health practitioner may dispense certain narcotic drugs for maintenance or detoxification treatment without registering with the DEA if the drug is prescribed by a health care practitioner through telemedicine. It preempts state laws related to licensure for this activity.

The law removed the federal barrier to pharmacists prescribing buprenorphine while leaving it up to each state to decide. An article about the legislation in the Journal of the American Pharmacists Association states, “Proponents of this campaign contended that the X-waiver requirements were outdated, unnecessary, and reflected a stigma around patients seeking treatment for OUD.” The reasoning behind the new relaxed requirements:

Preliminary studies have demonstrated that pharmacists collaborating with physicians to link people with OUD to buprenorphine treatment can improve patient care and reduce costs.

The barriers to access are unnecessary for a drug that can be self-administered and is not a likely candidate for abuse. Buprenorphine is a synthetic analog of thebaine, an alkaloid compound derived from the poppy flower. According to the National Institutes of Health, buprenorphine is “a Schedule III drug, which means it has a moderate-to-low potential for physical dependence.”

In a research brief on opioid treatment programs (OTPs), the Pew Trusts found that “nearly all states have rules governing OTPs that are not based on evidence and in turn limit access to care or worsen patient experience.” As of today, only a dozen states allow pharmacists to prescribe buprenorphine despite the growing need to curb opioid use disorder.

The latest state is Nevada, where legislators passed Assembly Bill 156 last year and last week Regulation R059-23 was approved by the Legislative Commission to allow Nevada pharmacists to prescribe buprenorphine and naltrexone. Pharmacists will still have to register with the State Board of Pharmacy and complete eight hours of addiction training.

For many small, rural communities with significant substance use disorder problems, there is no opioid treatment facility within 50 miles. There is not one single opioid treatment facility in Wyoming. For people with limited transportation options, being able to get buprenorphine and naltrexone from a local pharmacist may be the only way they can sustain a recovery program.

Written by Steve O’Keefe. First published March 5, 2024.

Sources:

“S.445 — Mainstreaming Addiction Treatment Act of 2021,” Congress.gov.

“Buprenorphine,” National Library of Medicine, retrieved March 4, 2024.

“Opportunities for pharmacist prescriptive authority of buprenorphine following passage of the Mainstreaming Addiction Treatment (MAT) Act,” Journal of the American Pharmacists Association, September-October 2023.

“Overview of Opioid Treatment Program Regulations by State,” Pew Trusts, September 19, 2022.

“Pharmacists in Nevada will soon be able to prescribe opioid addiction medication,” Nevada Current, February 28, 2024.

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