Bringing additional medication-assisted treatment (MAT) to bear on the nation’s addiction and overdose crisis appears to be top of mind for several federal leaders focused on behavioral health as well as key U.S. senators.
Leaders from agencies within the U.S. Department of Health and Human Services appeared before the Senate’s Health, Education, Labor and Pension Committee on Wednesday to discuss mental health and substance use challenges and government programs designed to address them.
The committee hearing is part of Congress’ attempt to produce a legislative package that seeks to address the already brittle mental health of Americans that was made worse by the onset of the coronavirus pandemic.
Committee Chair Sen. Patty Murray (D-Wash.) said that her goal, along with Ranking Member Richard Burr (R-N.C.), is to produce legislation by early summer. Fighting the growing overdose crisis and worsening mental health, especially among children, is a priority that Pres. Joe Biden outlined in his State of the Union address at the beginning of the month.
One such bill that could be part of the wider congressional effort before the committee is the Mainstreaming Addiction Treatment Act of 2021. Introduced to the committee at the end of February, the bill would remove the requirement that health care practitioners apply for waivers from the federal government to administer drugs for MAT, such as buprenorphine.
The so-called X-waiver is seen by many in the industry as a regulatory impediment to expanding access to MAT. Only about 5% of clinicians that are able to prescribe medication have an X-waiver.
The bill’s sponsor and committee member, Maggie Hassan (D-N.H.), said the current restrictions were outdated and highlighted that the bill has support from two key Republicans on the committee: Sen. Mike Braun of Indiana and Sen. Lisa Murkowski of Alaska.
MAT came up frequently from senators and from the federal leaders as well.
In her opening remarks, Murray said that the estimated more than 105,000 drug overdoses deaths in the U.S. for a 12-month period ending in October demonstrate a need for more to be done to address addiction.
“Those are really tragic and unacceptable numbers. They make clear that we really need to invest in treatment including medication-assisted treatment and prevention services for opioid use disorder,” Murray said. “But right now, just 1 in 5 Americans with opioid use disorder receive MAT, and there are significant disparities in access to that treatment.”
Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), told the committee that MAT reduces the risk of overdose by at least 60%. But she added that MAT isn’t fully effective unless it is administered along with a support system to help people struggling with an addiction stay in treatment.
Volkow also called for greater collaboration between the collective health care system and the justice system to ensure incarcerated peoples — 65% of whom are struggling with substance abuse disorders, according to NIDA research — get access to MAT, thus, ensuring health equity.
She also said that tougher enforcement of parity between health plan’s behavioral health and physical health benefits is key to ensuring a workforce that is able to meet the challenge of the addiction crisis.
In response to a question from Sen. Bill Cassidy (R-La.), Volkow said that states that have expanded access to Medicaid have seen evidence of better addiction treatment outcomes because of the increased access to MAT.
However, medication-assisted treatment has some major restrictions in addressing addiction treatment in general. Volkow, for instance, said that there are effective medications for only opioids, alcohol and tobacco use disorders.
NIDA is prioritizing the development of addiction medications, especially those that treat both mental health issues and addiction, as the two often co-occur.
“The escalating loss of life due to drug addiction has made evident the urgent need for interventions to prevent and treat emotional distress and mental disorders,” Volkow said.
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