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Opioid addiction treatment gets a boost in rural areas

Recovering opioid addicts will have greater access to a maintenance drug, especially in rural areas, under a measure announced on Tuesday by the federal Drug Enforcement Agency, a Minnesota expert on addictions said.

The new regulation gives nurse practitioners and physician assistants the ability to seek waivers giving them authority to prescribe and dispense buprenorphine, a drug used to help people quit or reduce use of opiates such as heroin. Brand names include Suboxone and Subutex.

Previously, only medical doctors were allowed to prescribe buprenorphine. But in a policy brief last year, the National Rural Health Association reported that only 2.2 percent of the physicians had obtained the necessary waivers, and 90 percent of those practiced in urban counties. That left 53 percent of rural counties and 30 million people without access to a prescribing physician, it said.

Carol Falkowski, director of the St. Paul-based Drug Abuse Dialogues, welcomed the news.

"To broaden out the prescribers is very good public health policy, and I think this is a positive step," she said.

Dr. Anne Stephen, the East region chief medical officer for Essentia Health, agreed.

"This is a great thing," she said. "The more that we can provide support for our patients in all areas, but specifically with opioid dependence, the better service we can provide."

Stephen said nurse practitioners and physician assistants in rural areas might be more likely than doctors to seek the required waivers.

"They are very patient-centered providers," she said. "What I've seen historically is that they step up their game when an opportunity arises like this."

But it's only a step, said Gary Olson, executive director of the Center for Alcohol and Drug Treatment in Duluth.

"Unfortunately, being waivered to prescribe is only the first hurdle," Olson wrote in an email, adding that support also is needed from addiction treatment specialists for the medication treatment approach to be most successful.

He also noted that the DEA regulation only brings that agency in line with policy already adopted by the U.S. Department of Health and Human Services.

Approved for clinical use by the Food and Drug Administration in 2002, buprenorphine plays a similar role as methadone in "medication-assisted treatment" for abuse of opiates such as heroin. It leads to long-term abstinence more often than abstinence-based treatment such as Narcotics Anonymous, according to studies cited by the National Rural Health Association. It's safer than methadone, according to those studies, and much less likely to result in an overdose.

Buprenorphine was the first medication for opioid treatment that could be prescribed or dispensed in a practitioner's office.

Making it more accessible is overdue, Falkowski said.

"There is no other ... chronic disease for which there is so much resistance to the use of medication and its treatment," she said. "We need to move forward in Minnesota and nationwide to make the accessibility of medication treatment for opiate addiction more broadly available."

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