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The Biden administration hopes to expand opioid addiction treatment


You've probably heard how opioid addiction continues to kill a lot of Americans - more than 80,000 deaths last year alone. What you may not know is there are really good medicines proven to help people avoid overdoses. But the overwhelming majority of people struggling with opioid addiction never get those medicines. Now the Biden administration wants to change that. NPR addiction correspondent Brian Mann reports.

BRIAN MANN, BYLINE: For decades, doctors and researchers like Dr. Linda Wang have had really safe, time-tested medications for treating opioid addiction, including buprenorphine and methadone.

LINDA WANG: If somebody has access to these lifesaving, effective medications, it cuts their mortality risk by 50%.

MANN: But public health experts say stigma in the health care system and strict government regulations mean 90% of people addicted to opioids never get these medications. Wang, who treats patients at Mount Sinai Hospital in New York, says this denial of basic health care is a deadly holdover from the era when addiction was seen as a crime, not an illness.

WANG: We were enacting a war on drugs and criminalizing drug use, and it was racist.

MANN: Studies show people of color have the hardest time gaining access to opioid addiction medications. Now the Biden administration is moving to reform rules for opioid treatment programs for the first time in 20 years, acknowledging the current system leaves millions of people vulnerable.

NEERAJ GANDOTRA: There were significant barriers that were quite stigmatizing for patients as they enter treatment.

MANN: Dr. Neeraj Gandotra is chief medical officer for the federal agency called SAMHSA that focuses on addiction treatment. Gandotra points out that right now even people who do manage to get these medications are often forced to visit a government-approved clinic every single day to get their dose.

GANDOTRA: The idea that they aren't allowed to get take-homes - that is a significant barrier.

MANN: During the COVID pandemic, the federal government and most states loosened opioid treatment rules on an emergency basis, making it easier to get medications with a telehealth visit, for example, and allowing more take-home doses. Dr. Brian Hurley, head of the American Society of Addiction Medicine, says that experiment worked.

BRIAN HURLEY: There was no evidence that diversion increased or that risk increased, but there was evidence that people who had access to treatment did better.

MANN: Danielle Russell (ph) is one of those patients. After struggling with heroin addiction, she's taken methadone for 10 years. It helped stabilize her life. She went back to school and is about to get her Ph.D. in justice studies. Russell says for the first time during the pandemic, she was finally allowed to take a full month's supply of methadone home, sparing her those daily trips to the clinic.

DANIELLE RUSSELL: I mean, not to sound dramatic, but it was life-changing, you know? I suddenly could live like a normal person.

MANN: This federal rule change, which is expected to be finalized, will lock in those pandemic-era reforms. It will also eliminate waiting periods for access to methadone and expand telehealth options even further. Everyone interviewed for this story agrees these rule changes will help, but they also say more reforms are needed that require congressional action. The goal, they say, is for opioid addiction medicines to finally be regulated like medications for other chronic diseases. Again, Dr. Neeraj Gandotra with the federal agency SAMHSA.

GANDOTRA: We hope that they are placed on the same spectrum as other conditions such as diabetes and hypertension. But I think it's too early to say whether this is a step towards that. We believe it is. But I have to say I'm not sure how far along we still have to go.

MANN: Public health experts say with street fentanyl driving more and more opioid deaths, pressure to keep improving access to these lifesaving medicines is growing fast. Brian Mann, NPR News. Transcript provided by NPR, Copyright NPR.

Brian Mann
Brian Mann is NPR's first national addiction correspondent. He also covers breaking news in the U.S. and around the world.