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WASHINGTON — The Biden administration on Tuesday announced it would move forward with a dramatic deregulation of addiction medicine first proposed by the Trump administration in January.

The change would allow almost any prescriber to treat patients using the drug buprenorphine, the most effective medication for opioid addiction. Currently, doctors, physician assistants, and nurse practitioners must undergo a separate training and apply for a waiver before they’re allowed to prescribe the drug to patients.


For years, many addiction physicians and public health advocates have argued that the “X-waiver,” as the special buprenorphine license is known, poses a barrier to basic care for patients with opioid addiction. In particular, many have argued that if a doctor can prescribe potentially addictive prescription pain drugs, they should also be able to prescribe the medicine used to treat the addiction.

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  • After 26 years of prescribing methadone and 19 years of prescribing buprenorphine for opioid use disorder, I find that those that are hooked to the point of seeking some way out (other than just more of the same or death) have all experienced a particular feeling, which I call “opiphoria.” This is variously described as “energy,” a “calm which passes all understanding,” an “elimination of all cares of the world,” or sometimes “superman” or “superwoman.” After listening to thousands of these histories, I perceive that this is a special and complicated problem. If you have not experienced these feelings (and I have not) it is difficult to fully understand those that have. I empathize with my patients, offer comprehensive evaluation, including mind, body, and spirit and pray that they will feel an even better feeling that only God can provide. I have always felt that there should not have been added certification for a safer medication nor limits on patient census as is evidenced by the success in France in the 90’s (everybody writes, nobody denied.) However, I hope the public does not expect a miracle from one very good tool, and that the prescribers will learn as much as possible about this rewarding aspect of medicine and actually start seeing these patients who are very much in need.

  • Where I reside, the last year has seen unprecedented drug overdose death counts, an increase mostly due to Covid-19 lockdown measures that basically abandoned all forms of addiction groups and counselling. I’m willing to bet that such blanket closures and indefinitely discontinued services somehow could have been avoided or at least mitigated.

    Although I haven’t been personally affected by the addiction/overdose crisis, I still understand the callous politics involved with this most serious social issue: Just government talk about funding to make proper treatment available to low- and no-income hard-drug addicts, however much it would alleviate their great suffering, generates firm opposition by the general socially and fiscally conservative electorate. The reaction is largely due to the preconceived notion that drug addicts are but weak-willed and/or have somehow committed a moral crime. Ignored is that such intense addiction usually does not originate from a bout of boredom, where a person repeatedly consumed recreationally but became heavily hooked on an unregulated often-deadly chemical that eventually destroyed their life and even that of a loved-one.

    The greater the drug-induced euphoria or escape one attains from its use, the more one wants to repeat the experience; and the more intolerable one finds their sober reality, the more pleasurable that escape should be perceived. By extension, the greater one’s mental pain or trauma while sober, the greater the need for escape from reality, thus the more addictive the euphoric escape-form will likely be. Sadly, the pain of their reality may be so overwhelming that even the most extreme and potentially permanent form of escape — suicidal behavior — is sometimes chosen.

    Regardless, we now know pharmaceutical corporations intentionally pushed their very addictive opiate pain killers — perhaps the real moral crime — for which they got off relatively lightly, considering the resulting immense suffering and overdose death numbers.

    • Well, there is the option of not taking drugs you do not need.

      I do not see how the drug companies, which do not go to the doctor and say they are in pain, nor accept the patient’s report and prescribe any medicine, should be blamed for individuals who want drugs and go to some trouble to get them getting addicted.

      What about holding individual’s responsible for what they do? The never ending drug war means people who need the painkillers, or cough medicine, or tranquilizers, can not get them, or barely get them. I wish the addicts well, but I do not want the rest of us to suffer because of their problems.

    • No, trump didn’t. Read the article, never mind, you gop only see what yall wanna see. Just so u don’t have to …. In January, when the Trump administration announced its highly similar proposal.

    • I am getting very tired of people who submit seemingly politically motivated ‘corrections’ when, in fact, they simply didn’t read the article closely enough.

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