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Lawmakers urge Biden to back opioid treatment measure

WASHINGTON — A bipartisan group of lawmakers is calling on President Biden to let more physicians prescribe an opioid treatment drug, in what has emerged as an early test of his administration’s opioid strategy.

The effort centers on the ’'X-waiver,’' a two-decade-old requirement, first mandated by Congress, that physicians undergo a day’s training before being allowed to prescribe buprenorphine for opioid-use disorder. Biden had criticized the prescribing rules as unnecessary last year and vowed to lift them if elected. But his administration instead preserved the rules last month by halting a last-minute Trump administration plan intended as a workaround, frustrating doctors and public health groups that say the rules are slowing the response to the nation’s worsening opioid crisis. The administration said the Trump plan was premature.


Now, lawmakers — led by Senators Maggie Hassan, Democrat from New Hampshire, and Lisa Murkowski, an Alaska Republican, who are joined by four members in the House — are reintroducing legislation that would eliminate the rules and urging the president to support the bill, calling on Biden to ’'deliver on your promise to expand access to medication-assisted treatment’' in a letter shared with The Washington Post.

’'This burdensome requirement does not improve patient safety, but does lead to treatment bottlenecks and a lack of providers across the country, particularly in rural areas,’' the lawmakers wrote Tuesday, adding that their legislation is the ’'best way’' to accomplish ’'our shared goal.

’'We respectfully request that you prioritize the elimination of the X-waiver in order to deliver on your promise to expand access to medication-assisted treatment.’'

The Biden administration is reviewing options to eliminate the waiver, said three administration officials, who spoke on the condition of anonymity because they were not authorized to discuss it.

’'We’re trying to do things the right way, and that will take some time,’' one official said. ’'We look forward to working with stakeholders on this issue, including Congress.’'


’'As overdose deaths rise, it’s critical that the federal government find ways to expand access to lifesaving medications for opioid use disorder,’' said a spokesman for the White House drug policy office. ’'For its part, the Office of National Drug Control Policy will continue its efforts to identify the best ways to provide greater access for these medications, reduce overdoses, and save lives.’'

Medical groups have hailed buprenorphine as a lifesaving treatment, particularly as the opioid crisis has accelerated during the coronavirus pandemic. The Centers for Disease Control and Prevention reported that more than 81,000 drug overdose deaths occurred in the United States during the 12-month period ended in May 2020, the highest 12-month death count on record.

Physicians also have long clamored to be able to more easily prescribe the drug, which blocks the effects of opioids and limits the symptoms of withdrawal.

’'Perhaps the Biden administration will eliminate the X-waiver in its own manner. But how can it justify further delay with overdose deaths increasing amid the pandemic?’' two Cleveland Clinic psychiatrists wrote in a Wall Street Journal op-ed on Monday. ’'If the administration lacks the courage to act now, we implore Congress to do so.’'

The Trump administration’s plan to get rid of the X-waiver, announced Jan. 14, sought to go around Congress’s requirement that physicians obtain a waiver by issuing new ’'clinical guidelines’' that would have enabled doctors with a Drug Enforcement Administration narcotics-prescribing license to avoid the training. But the plan had legal and operational problems, including a failure to receive necessary clearance from the White House budget office, said two officials who spoke on the condition of anonymity because they were not authorized to discuss the matter, and the Biden administration formally killed it in a terse 61-word announcement on Jan. 27.


Hassan and Murkowski had introduced their bill, the Mainstreaming Addiction Treatment Act, in the previous session of Congress, but it died in committee. The office of Senate majority leader Chuck Schumer, Democrat from New York, did not respond to requests for comment about whether he would support it.

The bill is also supported in the House by New York Democrats Paul Tonko and Antonio Delgado, and Ohio Republicans Anthony Gonzalez and Michael Turner.