Pennsylvania Bill Poised to Increase Barriers to Buprenorphine Access

    A Pennsylvania state senator intends to reintroduce a bill that would impose new regulations on buprenorphine providers and create additional barriers for people seeking buprenorphine treatment.

    State Sen. Michele Brooks, who represents parts of northwestern Pennsylvania, declared on January 8 that she would reintroduce Senate Bill 675 from the state General Assembly’s 2019-2020 session. The bill would mandate that buprenorphine providers pay a certification fee of up to $500 to obtain a license from the state. It would also ban patients with opioid use disorder (OUD) from being prescribed buprenorphine unless they participate in an addiction treatment program licensed by the state’s Department of Drug and Alcohol Programs.

    “Unfortunately, individuals across Pennsylvania are now using and abusing Suboxone/buprenorphine, and we must take steps to ensure that it is only prescribed in combination with drug and alcohol addiction treatments licensed by the Department of Drug and Alcohol Programs,” Brooks wrote in her January 8 memorandum. Brooks’ office did not answer Filter‘s request for comment.

    When SB 675 was introduced in 2019, it passed the Pennsylvania Senate with a 41-9 vote. It was then referred to the House’s committee on Human Services, where it did not receive a vote. 


    Effective Treatment

    Brooks’ would-be requirement that patients with OUD also seek counseling in conjunction with receiving medications for opioid use disorder (MOUD) perpetuates a myth that MOUD are insufficient treatment for OUD patients. Research has shown that, compared with other treatment pathways, only treatment with buprenorphine or methadone is associated with a reduced risk of overdose.

    “There is widespread myth and misunderstanding about these medications, and I think it’s coming from a place where there are still influential people who create this narrative that being on a medication is switching one drug for another,” Michael Botticelli, who led the Office of National Drug Control Policy during the Obama administration,told thePhiladelphia Inquirer.

    Brooks claimed in her memorandum that her legislation takes steps to prevent buprenorphine and Suboxone “abuse” by Pennsylvanians. But Suboxone use and diversion is nothing to fear; it frequently helps people to avoid much riskier opioid-use practices.


    Federal Restrictions

    While buprenorphine providers have not previously faced state oversight in Pennsylvania, there are already large hurdles at the federal level facing anyone who wants to prescribe buprenorphine for OUD. 

    Because of regulations in the Drug Addiction Treatment Act of 2000, physicians prescribing buprenorphine for OUD must first undergo an eight-hour training course to obtain a special waiver from the Drug Enforcement (DEA), dubbed the “X-waiver.” After obtaining the waiver, physicians are permitted to prescribe buprenorphine to up to 30 patients, and can later apply to increase that number.

    Under 7 percent of practitioners have obtained an X-waiver from the DEA. Around only half of all clinicians with an X-waiver to prescribe buprenorphine actually so.

    X-waivered physicians are especially rare in rural counties; nearly one-third of rural Americans live in a county without a buprenorphine provider. Three of the counties where Brooks’s constituents reside—Crawford, Mercer and Warren—are classified as rural.

    In the final days of the Trump administration, the Department of Health and Human Services announced that it would publish a guideline eliminating the X-waiver requirement for some medical practitioners, allowing them to prescribe buprenorphine to up to 30 patients. The Biden administration, however, is planning to oppose that change.



    Image of Pennsylvania Capitol from Wikimedia Commons/CC 3.0


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