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FDA Calls Kratom an Opioid

FDA Calls Kratom an Opioid

The Food and Drug Administration (FDA) is warning that the supplement known as “kratom” is an opioid and has been linked with 44 deaths, The Washington Post reports.

Kratom, an unregulated botanical substance, is used by some people to relieve pain, anxiety and depression, as well as symptoms of opioid withdrawal.

The FDA recently conducted a scientific analysis that provided even stronger evidence of kratom’s opioid properties, the agency said in a statement. “We have been especially concerned about the use of kratom to treat opioid withdrawal symptoms, as there is no reliable evidence to support the use of kratom as a treatment for opioid use disorder and significant safety issues exist,” said FDA Commissioner Scott Gottlieb.

The analysis has “contributed to the FDA’s concerns about kratom’s potential for abuse, addiction, and serious health consequences; including death.”

Original linkOriginal author: Ezra
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Naloxone Administration May Lead to Complications

Naloxone Administration May Lead to Complications

There seem to be a growing number of cases of high amounts of fluid in the lungs – known as noncardiogenic pulmonary edema – following administration of the opioid overdose antidote naloxone, experts said at a recent meeting of the New York Society of Addiction Medicine annual meeting.

“The cause of naloxone-associated pulmonary edema is unclear. It may be that it is part of the natural history of opioid overdose, and we are just seeing it more often because we have the ability to save patients using an antidote. It could also be because when we wake people with naloxone, they try to take a deep breath against a closed airway, causing barotraumas – injuries caused by increased air or water pressure,” says Nicholas Nacca, MD, Assistant Professor of Emergency Medicine and Medical Toxicologist at the University of Rochester Medical Center.

There is no hard data to support that this phenomenon has increased in frequency, but it certainly seems to be the case, he said. “The dose and route of administration have changed recently. Naloxone is now available in 4-milligram intranasal doses, which is higher than what we have used in the past,” said Dr. Nacca. “Previously, naloxone was available in 2-milligram doses.” In the controlled setting of an emergency room, toxicologists recommend giving the lowest dose of naloxone possible to reverse the respiratory arrest. This is different than in the field, where first responders, police and lay persons are using preloaded intranasal drug delivery devices.

“Lives are being saved by these doses of naloxone, and at this time, complications may be a necessary evil,” he said.

Another common issue with naloxone administration is that first responders may be used to administering naloxone via intramuscular or intravenous injection.

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New Treatment Guidance Issued For Pregnant Mothers with Opioid Use Disorder

New Treatment Guidance Issued For Pregnant Mothers with Opioid Use Disorder

The Substance Abuse and Mental Health Services Administration (SAMHSA) released new Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants.

SAMHSA’s Clinical Guidance comes at a time of great need for effective opioid use disorder (OUD) treatment.

In 2016, over 20,000 pregnant women reported using heroin or misusing pain relievers in the past month. Newborn babies of mothers who used opioids while pregnant are at risk of neonatal abstinence syndrome--a group of physical and neurobehavioral signs of withdrawal.

“SAMHSA is filling an urgent need for reliable, useful, and accurate information for healthcare professionals working to treat opioid dependent mothers and their children,” said Dr. Elinore F. McCance-Katz, SAMHSA’s Assistant Secretary for Mental Health and Substance Use. “Ultimately, the steps explained in this guidance will help the mother and her infant safely receive treatment for opioid use disorder and neonatal abstinence syndrome.”

The Clinical Guidance offers standard approaches to a range of real-world scenarios faced by healthcare professionals working with mothers and infants. For each scenario, the guidance offers clinical action steps and supporting evidence. The action steps reflect the best available treatment, including medication-assisted treatment for the mother and infant and appropriate types of social supports and follow-up services.

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Getting the Right Help for Opioid Dependence or Withdrawal

Getting the Right Help for Opioid Dependence or Withdrawal

Do you know someone seeking treatment for opioid dependence or withdrawal?

If so, it’s important to know this: products that promise miracle cures or fast results cancost precious time and money, lead to relapse, and even be dangerous.

Dietary supplements — such as herbal blends, vitamins, and minerals — have not been scientifically proven to ease withdrawal or to treat opioid dependence.Products like Kratom, which some claim can help, are actually not proven treatments, and can be addictive and dangerous to your health.Opioid dependence and withdrawal are serious health issues. You can address them with time, hard work, and help. But there are no quick fixes.

If you or someone you know is considering treatment for opioid dependence or withdrawal, start here:

Call SAMHSA’s National Helpline: 1-800-662-HELP (4357)Get live help from this free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for people and families facing substance use disorders.Visit SAMHSA’s confidential treatment locator: https://findtreatment.samhsa.govFind a reputable treatment facility near you in a quick, confidential online search.

Before taking any dietary supplement — for any medical reason — ask a health provider these questions:

Is there scientific proof it actually works?How reliable is this brand?How will it interact with other supplements or drugs I take?What are the side effects?If it’s safe to take, what’s the right amount?

Learn more by clicking here.

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Antipsychotic Drugs May Finally Be Poised For a Long-Overdue Makeover

Antipsychotic Drugs May Finally Be Poised For a Long-Overdue Makeover

Antipsychotic drugs – which transformed mental health care following their chance discovery in the mid-20th Century – may finally be poised for a long-overdue makeover incorporating structure-based design.

Scientists funded by the National Institutes of Health have achieved a landmark of psychiatric neuropharmacology: deciphering the molecular structure of a widely prescribed antipsychotic docked in its key receptor. They are hopeful that this discovery may hold secrets to designing better treatments for schizophrenia, bipolar disorder, and other mental illnesses.

“For the first time, we can understand precisely how atypical antipsychotic drugs bind to their primary molecular target in the human brain,” explained Dr. Laurie Nadler, chief of the neuropharmacology program at the National Institute of Mental Health (NIMH), which co-funded the study along with the National Institute of General Medical Sciences and the National Cancer Institute. “This discovery opens the way for the rational design of a new generation of antipsychotic drugs, hopefully with more desirable effects and fewer side effects.”

Researchers Bryan Roth, M.D., Ph.D. (link is external), of the University of North Carolina (UNC) Chapel Hill, Brian Shoichet, Ph.D., (link is external) of the University of California San Francisco, and colleagues, report on their discovery of the crystal structure of the antipsychotic risperidone docked in the D2 dopamine receptor in the journal Nature.

Before becoming a laboratory scientist, psychiatrist Roth experienced first-hand the limitations of existing antipsychotics while treating patients with schizophrenia. The medications excel at quelling hallucinations and delusions, yet largely fail to address schizophrenia’s debilitating cognitive and social impairments, while increasing risk for movement disorders, weight gain, and other metabolic and cardiovascular side effects.

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Children of Alcoholics Week is Held February 11-17 2018

Children of Alcoholics Week is Held February 11-17 2018

Children of Alcoholics (COA) Week is a campaign led by Nacoa (The National Association for Children of Alcoholics) to raise awareness of children affected by parental alcohol problems.

Imagine coming home from school and dreading what you might find. Imagine having no friends because you’re too embarrassed to bring them home in case mom or dad are drunk, or worse. Imagine living in a home full of fear and having no one to turn to because everyone denies there’s a problem.

Together we can increase awareness of this hidden problem and the support available. Find out how you can help children of all ages know they are not alone.

This year, under the slogan “All you need is Love”, the Children of Alcoholics week activities of Active – Sobriety, Friendship and Peace reflect on love and safety, as not just feelings that children experience, but also part of children’s rights.

Children of Alcoholics Week is celebrated internationally each year during the week in which Valentine’s Day falls. There are organisations holding COA Week activities in USA, Germany, Poland, Sweden and Slovenia.

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Fentanyl-Related Substances Temporarily Placed as Schedule I Drugs

Fentanyl-Related Substances Temporarily Placed as Schedule I Drugs

It is well known that deaths associated with the abuse of substances structurally related to fentanyl in the United States are on the rise and have already reached alarming levels.

While a number of factors appear to be contributing to this public health crisis, chief among the causes is the sharp increase in recent years in the availability of illicitly produced, potent substances structurally related to fentanyl. Fentanyl is approximately 100 times more potent than morphine, and the substances structurally related to fentanyl that DEA is temporarily controlling also tend to be potent substances. Typically, these substances are manufactured outside the United States by clandestine manufacturers and then smuggled into the United States.

As a result, the Administrator of the Drug Enforcement Administration has issued a temporary scheduling order to schedule fentanyl-related substances that are not currently listed in any schedule of the Controlled Substances Act (CSA) and their isomers, esters, ethers, salts and salts of isomers, esters, and ethers in schedule I.

This action is based on a finding by the Administrator that the placement of these synthetic opioids in schedule I is necessary to avoid an imminent hazard to the public safety. As a result of this order, the regulatory controls and administrative, civil, and criminal sanctions applicable to schedule I controlled substances will be imposed on persons who handle (manufacture, distribute, reverse distribute, import, export, engage in research, conduct instructional activities or chemical analysis, or possess), or propose to handle fentanyl-related substances.

This temporary scheduling order is effective February 6, 2018, until February 6, 2020.

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Study of First-Graders Shows Fetal Alcohol Spectrum Disorders Prevalent In U.S. Communities

Study of First-Graders Shows Fetal Alcohol Spectrum Disorders Prevalent In U.S. Communities

NIH-funded research examined over 6,000 children to determine prevalence of FASD ranged from 1.1 to 5 percent.

A study of more than 6,000 first-graders across four U.S. communities has found that a significant number of the children have fetal alcohol spectrum disorders (FASD), with conservative rates ranging from 1 to 5 percent in community samples. The new findings represent more accurate prevalence estimates of FASD among general U.S. communities than prior research. Previous FASD estimates were based on smaller study populations and did not reflect the overall U.S. population. The study was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health.

FASD is an umbrella term for a range of health effects caused by prenatal alcohol exposure. Individuals with FASD may experience growth deficiencies, facial abnormalities, and organ damage, including to the brain. The effects of prenatal alcohol exposure on the brain can result in a range of neurobiological deficits that contribute to physical, cognitive, behavioral, and social challenges throughout life.

“Prenatal alcohol exposure is a leading preventable cause of developmental disabilities worldwide,” said NIAAA Director George F. Koob, Ph.D. “Estimating the prevalence of FASD in the United States has been complex due to the challenges in identifying prenatally exposed children. The findings of this study confirm that FASD is a significant public health problem, and strategies to expand screening, diagnosis, prevention, and treatment are needed to address it.”

The study was conducted by the Collaboration on Fetal Alcohol Spectrum Disorders Prevalence (CoFASP) consortium, which studies the prevalence of FASD among U.S. school children. Before the study began, consortium members established standardized classification criteria for FASD based on facial features, growth, and neurodevelopmental performance. Co-led by Philip May, Ph.D., of the University of North Carolina Nutrition Research Institute, Kannapolis, and Christina Chambers, Ph.D., of the University of California San Diego School of Medicine, the findings are reported online in the Journal of the American Medical Association.

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Philadelphia Encourages Development of Sites for Supervised Injection Drug Use

Philadelphia Encourages Development of Sites for Supervised Injection Drug Use

Philadelphia officials are encouraging organizations to open facilities where staff members provide clean needles and guard against overdoses.

Advocates for these facilities say they would save lives. Opponents say they sanction an illegal activity, and make it easier for people to use drugs, The Wall Street Journal reports.

The Philadelphia facilities would offer a wide range of services, including referrals to treatment and social services, wound care, medically supervised drug consumption, and access to sterile injection equipment and the opioid overdose antidote naloxone, according to a news release.

City officials said a scientific review of studies of supervised injection facilities showed they reduce deaths from drug overdose; prevent HIV, hepatitis C and other infections; and help people who use drugs get into treatment.

The review estimated that one site in Philadelphia could prevent up to 76 deaths from drug overdose each year.

Original linkOriginal author: Ezra
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What Today’s Parents Should Know About the Gateway Drug Theory

What Today’s Parents Should Know About the Gateway Drug Theory

While scanning the latest news, it’s easy to feel as if we’ve traveled back in time to the 1980s. “Just say no?” “The war on drugs?”

After nearly three decades, there’s still little evidence to suggest these outdated addiction prevention and treatment strategies work, and some evidence even shows that they are counterproductive. Yet, they continue to influence how we both talk about and treat addiction. And just last month, dialogue about the “gateway drug theory” resurfaced in the New York Times, raising the question: is this highly publicized hypothesis, which also originated in the final quarter of the 20th century, grounded in fact or fiction? We answer this question – and more – below.

WHAT IS THE GATEWAY DRUG THEORY?First popularized in the 1980s, the gateway drug theory purports that adolescent use of tobacco, alcohol or marijuana increases an individual’s risk of using and/or developing addiction to other licit and illicit substances that may be perceived as more harmful, such as opioids, cocaine and methamphetamines.

ARE TOBACCO, ALCOHOL AND MARIJUANA GATEWAY DRUGS?In a sense, yes, but the important thing to note is that every drug is a gateway drug if used during adolescence or young adulthood while brain development is still underway.Whether it’s nicotine, alcohol, marijuana or opioids, it is the age of the person initiating use – not the specific substance itself – that increases the risk of using other addictive substances and developing addiction.

WHY ARE YOUNG PEOPLE WHO SMOKE, DRINK OR USE DRUGS MORE SUSCEPTIBLE TO DEVELOPING ADDICTION?During adolescence, the human brain goes through numerous developmental changes in structure and function. While the areas of the brain associated with memory, learning, judgment, decision-making, risk-taking, reward, emotion and stress are maturing, they are uniquely vulnerable to the damage that addictive substances such as nicotine, alcohol and other drugs inflict on these critical brain functions. That damage to the brain not only makes the individual more susceptible to addiction, but it also further impairs the skills needed to make good decisions and sound judgements, heightening the risk of future substance use and addiction.

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Opioid Public Health Emergency Renewed for Another 90 Days

Opioid Public Health Emergency Renewed for Another 90 Days

The Trump Administration renewed the order declaring the opioid crisis a public health emergency on January 22, a day before the 90-day mandate was set to expire, ABC News reports.

The Department of Health and Human Services has not said whether the public health emergency will be renewed every 90 days, the article notes.

In October, President Trump declared the opioid crisis a public health emergency. The order waives regulations and gives states more flexibility in how they use federal funds to combat the crisis.

Under a public health emergency, states could temporarily shift federal grant funds from a wide range of public health issues—such as HIV, diabetes and maternal care—to fund opioid treatment programs. A public health emergency is not as sweeping as a national emergency, which would give the president even more power to waive privacy laws and Medicaid regulations, the article notes.

Original linkOriginal author: Ezra
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Fear Factor: Do Scare Tactics Keep Teens from Using Drugs

Fear Factor: Do Scare Tactics Keep Teens from Using Drugs

Thinking back to your middle school or high school health classes, you may recall photographs of lungs blackened by cigarette tar or videos of teenagers dropping out of school, fighting with friends and family, or even dying because of their errant drug and alcohol use.

Exposing children and teenagers to the most damaging consequences of these behaviors has long been a mainstay in America’s addiction prevention strategy – but that poses the question: do scare tactics work?

There is evidence to suggest that scaring people can help them adopt or avoid certain behaviors – this is especially true when the proposed negative outcome is paired with an “efficacy method” or something people can do to eradicate the fear.

It also tends to work better when it comes to:

One-time only or infrequent prevention behaviors, e.g., going to the dentist for a checkupBehaviors that detect a health problem, e.g., having a suspicious mole checked for cancer, getting a mammogram

And worse for:

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FDA Asks Makers of Anti-Diarrhea Drug to Change Packaging to Curb Abuse

FDA Asks Makers of Anti-Diarrhea Drug to Change Packaging to Curb Abuse

The Food and Drug Administration (FDA) this week asked the makers of the over-the-counter anti-diarrhea drug loperamide (Imodium A-D) to change the way they package their products, in an effort to reduce abuse.

Some people take extremely high doses of loperamide in an attempt to manage opioid withdrawal symptoms or to achieve euphoric effects of opioid use, the FDA said in a statement.

Loperamide is safe when used at recommended doses, The Washington Post reports. But when it is taken at extremely high doses, the drug can cause dangerous, irregular heartbeats.

The FDA is asking manufacturers to redesign their packages so they contain only enough medication for short-term use. The agency is also asking for “unit dose packaging,” such as blister packs that require a person to unpeel each dose separately.

Original linkOriginal author: Ezra
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Illicit Fentanyl Use Linked to Cases of Amnesia

Illicit Fentanyl Use Linked to Cases of Amnesia

More than a dozen people who used fentanyl, either alone or in combination with stimulants, have suffered severe memory loss, researchers from West Virginia University report.

These cases involved severe short-term memory loss, HealthDay reports.

Imaging scans revealed the patients had lesions on the hippocampus, a region of the brain associated with memory. The patients did not recovery quickly, and may never fully regain their short-term memory, according to lead researcher Marc Haut.

“They all have difficulty learning new information, and it’s pretty dense,” Haut said. “Every day is pretty much a new day for them, and sometimes within a day they can’t maintain information they’ve learned.” He added, “Based upon the imaging, I would be surprised if they didn’t have at least some significant memory problems permanently.”

The findings are published in the Annals of Internal Medicine

Original linkOriginal author: Ezra
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Nurse Practitioners and Physician Assistants Now Eligible to Prescribe Buprenorphine

Nurse Practitioners and Physician Assistants Now Eligible to Prescribe Buprenorphine

Nurse practitioners and physician assistants will now be eligible to prescribe and dispense the opioid addiction treatment buprenorphine from their office, Reuters reports.

The Drug Enforcement Administration said the change will make it easier for residents of underserved areas to receive treatment for opioid addiction.

The new rule is a result of the Comprehensive Addiction and Recovery Act (CARA), passed in 2016.

The law expanded access to substance use treatment services and overdose reversal medications by extending the privilege of prescribing buprenorphine in office-based settings to qualifying nurse practitioners and physician assistants. CARA requires that nurse practitioners and physician assistants complete 24 hours of training to be eligible to prescribe buprenorphine.

“This action reflects this work and the ongoing need to further expand access to the most effective treatment for opioid use disorder,” David Fiellin, Professor of Medicine, Emergency Medicine and Public Health at Yale School of Medicine, told Reuters.

Original linkOriginal author: Ezra
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Trump Plans to Slash Drug Policy Office Budget

Trump Plans to Slash Drug Policy Office Budget

The Trump Administration is planning to cut more than $340 million from the budget of the White House Office of National Drug Control Policy (ONDCP), CBS News reports.

The administration will eliminate the agency’s grant-making capabilities, according to the article. Two grant programs–the High Intensity Drug Trafficking Areas (HIDTA) and Drug-Free Communities (DFC)–would be relocated to, and managed by, the Department of Justice and Department of Health and Human Services.

According to a spokesperson from the White House Office of Management and Budget, the administration’s 2019 budget is not final.

HIDTA provides assistance to federal, state, local, and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the United States. DFC is the largest drug prevention program in the U.S.

Original linkOriginal author: Ezra
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New Report Finds That Using E-Cigarettes May Lead Youth to Start Smoking, Adults to Stop Smoking

New Report Finds That Using E-Cigarettes May Lead Youth to Start Smoking, Adults to Stop Smoking

A new congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine takes a comprehensive look at evidence on the human health effects of e-cigarettes. Although the research base is limited given the relatively short time e-cigarettes have been used, the committee that conducted the study identified and examined over 800 peer-reviewed scientific studies, reaching dozens of conclusions about a range of health impacts.

Evidence suggests that while e-cigarettes are not without health risks, they are likely to be far less harmful than conventional cigarettes, the report says. They contain fewer numbers and lower levels of toxic substances than conventional cigarettes, and using e-cigarettes may help adults who smoke conventional cigarettes quit smoking. However, their long-term health effects are not yet clear. Among youth -- who use e-cigarettes at higher rates than adults do -- there is substantial evidence that e-cigarette use increases the risk of transitioning to smoking conventional cigarettes.

E-cigarettes are a diverse group of products containing a heating element that produces an aerosol from a liquid that users can inhale via a mouthpiece, and include a range of devices such as “cig-a-likes,” vape tank systems, and vape mods. Millions of Americans use e-cigarettes, and e-cigarette use is generally greatest among young adults and decreases with age. Use varies substantially across demographic groups, including age, gender, race, and ethnicity. For example, among youth and adults, use is typically greater among males than females.

Whether e-cigarettes have an overall positive or negative impact on public health is currently unknown, the report says. More and better research on e-cigarettes’ short- and long-term effects on health and on their relationship to conventional smoking is needed to answer that question with clarity.

“E-cigarettes cannot be simply categorized as either beneficial or harmful,” said David Eaton, chair of the committee that wrote the report, and dean and vice provost of the Graduate School of the University of Washington, Seattle. “In some circumstances, such as their use by non-smoking adolescents and young adults, their adverse effects clearly warrant concern. In other cases, such as when adult smokers use them to quit smoking, they offer an opportunity to reduce smoking-related illness.”

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Walmart to Help Customers Safely Dispose of Opioids

Walmart to Help Customers Safely Dispose of Opioids

Walmart will give customers filling opioid prescriptions a packet of powder they can use to safely dispose of leftover medication, Reuters reports.

Patients filling opioid prescriptions at Walmart or Sam’s Clubs pharmacies will receive a free packet of DisposeRx. To safely dispose of opioids, a person adds warm water and the powder to their pill bottle, which then forms a biodegradable gel around the pills.

According to a Walmart news release, “Beginning immediately, patients filling any new Class II opioid prescription at Walmart pharmacies will receive a free DisposeRx packet and opioid safety information brochure when picking up their prescription. Patients with chronic Class II opioid prescriptions will be offered a free DisposeRx packet every six months.”

Original linkOriginal author: Ezra
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Recreational marijuana legalization: Do more youth use or do youth use more?

Recreational marijuana legalization: Do more youth use or do youth use more?

What impact may legalization of recreational marijuana in Oregon have on teen marijuana use?

Recent results from an Oregon Research Institute (ORI) study indicate that the influence of legalization on youth may depend on whether they were already using at the time of legalization.

Following legalization of recreational marijuana, no significant changes in the numbers of youth who used marijuana occurred, yet increases in the frequency of use by youth who were already using marijuana were found.

For teenagers who had tried marijuana by 8th grade, the frequency of use during the following year increased 26% more for those who were in 9th grade after marijuana was legalized compared to those who were in 9th grade prior to legalization.

The research results are published online in Psychology of Addictive Behaviors.

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DEA Announces Step to Increase Opioid Addiction Treatment

DEA Announces Step to Increase Opioid Addiction Treatment

The United States Drug Enforcement Administration announced a deregulatory measure that will make it easier for residents of underserved areas to receive treatment for opioid addiction.

As published in the Federal Register, nurse practitioners and physician assistants can now become DATA-Waived qualifying practitioners, which give them authority to prescribe and dispense the opioid maintenance drug buprenorphine from their offices.

Prior to the enactment of the Drug Abuse Treatment Act of 2000, only physicians could treat opioid addicts and had to register with DEA as both physicians and operators of Narcotic Treatment Programs. Waiving this second registration prompted more physicians to offer treatment services. The Federal Register notice is available here:

This action brings DEA regulations into conformity with the Comprehensive Addiction and Recovery Act passed by Congress and signed into law in 2016. Because the vast majority of DATA-Waived physicians prior to CARA served urban areas, rural parts of the United States were underserved. This action provides more treatment options for addicts in rural parts of the country.

According to a 2017 report published by the National Rural Health Association, 90 percent of DATA-Waived physicians practice in urban counties, leaving 53 percent of rural counties without any prescribing physician and 30 million people living in counties where treatment is unavailable. As a result, rural patients seeking outpatient buprenorphine treatment must often travel long distances to access care. Rural providers of buprenorphine report a demand far beyond their capacity and say they lack the resources to adequately support themselves and patients in treatment. The NRHA report also found that, with 92 percent of substance use treatment facilities located in urban areas, rural areas offer fewer inpatient and day treatment resources.

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