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DEA Moves to Help Rural Americans Get Medication-Assisted Addiction Treatment


In January, medical professionals gained a leg up on the opioid crisis. That is when the U.S. Drug Enforcement Administration (DEA) announced a new rule change allowing rural areas to benefit from medication-assisted addiction treatment provided by nurse practitioners and physician assistants.

This article looks at the rule change and how it may help improve outcomes for rural Americans addicted to opioids.

Deregulation and Addiction Treatment

Prior to the recently amended ruling, the rules for medication-assisted treatment (MAT) had not changed since October 2000, when Congress passed DATA, the Drug Addiction Treatment Act. The law permitted approved physicians to prescribe narcotic controlled substances such as buprenorphine to help addicted patients recover from opioids. The law required physicians to obtain a DEA registration in order to prescribe MAT. Once approved, the physicians could treat 30 or 100 patients, depending upon the waiver received.

In January 2018, the rules were adjusted to allow a wider range of midlevel providers, specifically physician assistants (PAs) and nurse practitioners (NPs), to treat patients with these medications. The January ruling reversed earlier rules allowing only qualified, approved, and DEA registered doctors to have prescribing rights.

Addiction treatment

The DEA’s press release on this rule change said the new regulations would bring the agency into compliance with the 2016 Comprehensive Addiction and Recovery Act. The law sought to expand the availability of naloxone to reverse opioid overdose, improve PDMP programs, and to shift more support to U.S. prisons and jails to provide addiction treatment for the incarcerated. The release said there are currently 43,000 DATA-waived physicians prescribing MAT in the U.S. It is anticipated this new action will move more than 48,000 midlevel providers potentially into the addiction treatment safety net. 

The DEA made this unusual move in an effort to widen the treatment safety net for opioid use, especially in rural counties. According to the Washington Post:

  • 53 percent of rural counties in the U.S. face a serious physician shortage.
  • Overall, the United States is anticipating a shortage of 90,000 physicians by 2025.
  • This shortage is occurring at a time when the Baby Boomer population is expected to place great strain on the healthcare system.
  • This shortage also occurs within the context of the greatest drug epidemic in modern history.

The National Rural Health Association reports that 90 percent of the DATA-approved doctors are located in urban areas. They estimate around 30 million people live in rural settings where no MAT prescribing physicians are practicing. 

The move by the DEA could not come at a better time; the latest CDC studies point out that drug overdoses are higher in rural areas. By finally allowing midlevel providers prescribing rights for MAT, medical professionals have an opportunity to increase the level of care in rural settings as well as urban settings. Now there is a better chance of bringing addiction treatment to substance users where they live, instead of placing the added burden of having to travel to find a physician able to provide addiction treatment.

With the opioid crisis hitting rural areas particularly hard, allowing midlevel providers to prescribe drugs like methadone is a step in the right direction. 

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