After injecting heroin for more than 20 years, Teal McDonald found a reprieve in in buprenorphine, a drug prescribed by a doctor to kill her craving for opioids.
“I actually went back to work and got a job at a dealership selling cars,” said McDonald, who also tried methadone during years of struggles to stay drug-free. “It was a good time of stability for me after being on the street and having a lot of challenges.”
Like many heroin users, McDonald’s path to addiction started in the doctor’s office — she developed a taste for opioids after being prescribed pain pills as a pre-teen. Indeed, some 80% of users say they took prescription opioids before ever trying heroin.
But while any doctor can prescribe potentially addictive opiates, only 2,500 in Texas can prescribe buprenorphine.
That’s because the Drug Enforcement Agency requires medical professionals to obtain a waiver before they can offer the drug. Doctors must complete eight hours of training before they can apply for one, while physician assistants and nurse practitioners need 24 hours of training.
Dr. Jennifer Sharpe Potter, a UT Health San Antonio professor of psychiatry, said that training can be difficult for busy professionals to fit in, and it’s not always accessible in rural communities hit hard by the opioid epidemic.
Potter worries the good intentions behind the waiver — it’s meant to give doctors a better understanding of addiction treatment — are standing in the way of dealing with a health crisis. Texas recorded 1,458 overdose deaths in 2017, more than any previous year on record.
“Given the current situation with overdoses where they are, the waiver is a significant barrier,” Potter said. “Requiring that many hours of training to prescribe one kind of medication is excessive. It’s crazy.”
To that end, Potter started a program called Get Waivered TX, which takes the training to medical professionals around the state. So far, 450 medical professionals have completed its workshops in 36 Texas communities — including places as remote as Uvalde and Alpine.
Potter has seen the difference buprenorphine can make to people battling opioid use disorder, or OUD. The treatment allows patients to more easily stay in long-term recovery because it can be administered by a physician on an outpatient basis.
Teal McDonald says buprenorphine helped calm her craving for opioids.
People treated with buprenorphine are 50% less likely to overdose, she points out, and half ultimately recover from their disorder.
“When people are treated with buprenorphine, their lives are transformed,” she said.
Dr. Sally Combest of Boerne obtained a waiver through Potter’s program and said she buprenorphine offers “dignity, privacy, flexibility and safety” to patients battling OUD.
“There are a lot of people who would never go to a methadone clinic,” Combest said. “For a lot of people, this may be the only way they’ll seek treatment.”
Given the high stakes of the opioid crisis, federal lawmakers are showing a willingness to rethink the waiver.
The U.S. House recently introduced the Mainstreaming Addiction Treatment Act, which would strike down the training requirement. A similar bill has been introduced in the Senate. What’s more, 39 state attorneys general have signed onto a letter supporting those measures, although Texas Attorney General Ken Paxton was not among them.
“Burdensome federal rules make it harder for our medical professionals to prescribe addiction treatment medications — harder, in fact, than to prescribe the powerful opioids that got our community into this crisis,” said Lloyd Doggett, a San Antonio Democrat who signed on to sponsor of the House bill.
Doggett commended UT Health’s Potter and others for clearing the way for more medical professionals to obtain waivers.
Even so, “our local champions cannot fight this alone,” he said. “We need to tear down federal, bureaucratic barriers to treating substance use disorder, while ensuring that those who benefit from opioid medication still have access.”
McDonald, the recovering heroin user, said she hopes the restrictions can be lifted. While she ultimately cleaned up without the use of buprenorphine, she sees it as a lifesaver for others.
“It’s frustrating that it still has restrictions,” she said. “Especially knowing people are dying out there.”
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