Improving access to addiction treatment and disrupting the supply of illicit drugs will be the big goals this year for the Office of National Drug Control Policy (ONDCP), according to its director, Rahul Gupta, MD, MPH.
One big order of business will be to fully implement the Mainstreaming Addiction Treatment (MAT) Act, which was included in the omnibus spending bill passed in December, Gupta said Thursday during a phone interview at which a press person was present. The MAT Act gets rid of the requirement that physicians and other clinicians get an “X waiver” before being able to prescribe buprenorphine to patients with opioid use disorder.
“That includes making sure that physicians and providers are aware” that the X waiver is gone, Gupta said, adding that he also wants to ensure that pharmacies are stocking the drug and that manufacturers continue to manufacture it. “There are millions of people that need treatment, but less than 1 in 10 are getting it.”
Gupta said he also wants to continue some of the healthcare improvements that have ramped up during the COVID-19 pandemic, including regulations temporarily allowing for increased use of telehealth for all patients — including those with substance use disorders (SUDs) — as well as rules allowing SUD patients to take methadone home rather than have it dispensed to them in the clinic. ONDCP wants to make those rules permanent, he said.
“One of the most sad things I’ve seen is when people have to take time off; oftentimes, they can’t afford to go and get the methadone in the clinic every single day,” he said. “That’s what their life becomes about.”
Harm reduction is another important part of the ONDCP’s strategy, according to Gupta. He listed the three areas his office is focusing on:
- Naloxone distribution. Gupta said he favors making naloxone available over the counter nationally. “Three or four people are dying each day because of opioids — often, illicit fentanyl,” he said. “If these folks had access to naloxone, or if their friends and family did, we would be saving tens of thousands of lives immediately. And we know from studies that every dollar invest in naloxone saves $2,800. So it’s a huge cost-effective measure.”
- Syringe service programs. “We know these are cost-effective to not only prevent severe communicable diseases like HIV and hepatitis C, but then also they have had significant improvements in connecting people to treatment and other benefits,” Gupta said.
- Drug checking for fentanyl with test strips. “Because fentanyl is so pervasive in our drug supply, we want to make sure people have the ability to check that so they’re not surprised … The federal government is funding them for the first time so people can check their drug supply and make the appropriate decision,” he said.
Improving care for incarcerated SUD patients is another big focus, Gupta said. “In carceral settings, 60% to 80% of people who are actually behind the walls have a diagnosis of substance use disorder. So we’re trying to make sure that we can get every person who’s behind the wall access to the same treatment that we’re talking about for everybody else.” SUD patients’ risk of overdose death rises 40-fold in the first 2 to 4 weeks after they are released from prison, so treating these patients before they’re released is very beneficial, and it also reduces recidivism, he said.
The ONDCP has been working for several months with the Federal Bureau of Prisons, the Drug Enforcement Administration, HHS, and the Centers for Medicare & Medicaid Services on solutions. Although Gupta said they don’t have anything to announce yet, he added that “the president is very clear that nobody should be incarcerated for their drug use alone,” he said. “And that’s not only right, but that’s one thing that I think will have a lot of benefits to the community by not using incarceration as a tool to treat addiction.”
Prevention is another top priority, Gupta said. “We’ve been working with the American Academy of Pediatrics and others to think about how to get out the prevention message about fentanyl pills. Obviously, 40% of the illicit pill supply out there has a potentially lethal dose of fentanyl in it. And we want to make sure that everybody’s aware — especially youth — that getting pills not prescribed to you by a provider and not getting it from a pharmacy is one of the most dangerous things you can do.”
For patients who do experience a drug overdose, Gupta said his office wants to develop a better treatment structure, one in which treatment with naloxone can be started in the emergency department and then patients can be connected with treatment providers in the community for follow-up. The administration is also trying to make treating SUD patients more financially rewarding for providers. “We’re working with CMS to see about other opportunities …. Medicaid waivers or state waivers to make sure that treatment not only is the right thing to do but it also makes sense from a financial perspective as well,” he said.
Finally, the administration is working to disrupt the illegal drug supply chain, said Gupta. “We know it’s not about one particular drug — it’s about profit-making. And it begins all the way from China and ends up in our community. So for the first time, we’re taking a ‘whole of federal government’ approach along with those state and local partners to go after the profit-making machine that leads to victimizing Americans.”
Asked what has surprised him most in his job so far, Gupta said it was “the disproportionate need to focus on the services that make treatment successful, that make recovery possible, that turn recovery from a possibility into a probability.”
Housing is at the top of that list, he said: “A simple thing like the housing can have so much impact on one’s life, because it’s really grounding and stabilizing. It allows you to not only be successful in treatment, but to find community, find employment, and other things.”