HHS Expands Access to Treatment for Opioid Use Disorder
hhs.gov
hhs.gov
For example, on day one of residency, I was allowed to prescribe unlimited quantities of intravenous opioids to people with no additional training. Those were DEA schedule 2 substances--the classification that is deemed most dangerous but which may have appropriate medical use. This classification includes fentanyl, oxycodone, hydromorphone, methamphetamine, and even intranasal cocaine.
But to provide a life-saving treatment for opioid use disorder with a schedule 3 substance like buprenorphine (which by definition would be considered less dangerous than fentanyl or hydromorphone[1]), I had to have an additional 8 hours of training and other reporting requirements that wouldn't be required to run an opioid pill mill.
Buprenorphine isn't perfect, and it isn't for everyone. But the molecule itself is generally safer than alternatives like methadone[2]. It's made a huge difference to so many of my patients. (That's just anecdote: mortality studies suggest it reduces overdose deaths by 70% and all-cause mortality by 55% [3]. That's much larger than almost any other treatment for a chronic disorder in medicine).
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[1] The scheduling system is a little silly. Schedule 1 substances have no approved clinical use, and so things that are highly unlikely to kill people like marijuana are rated as higher risk. But schedules 2-5 are in a very rough rank-order of risk when misused.
[2] The way methadone is regulated may make it's mortality benefit better than buprenorphine despite it being a riskier substance. Initial dosing is in-person 6-days per week for at least three month, and then incentives allow people to bring home more doses with continue success in recovery.