Is the waiver requirement a barrier?
Some suggest that the waiver requirement is a barrier to having more frontline clinicians prepared to provide MAT. But how much of a barrier is this requirement to get a waiver?
The waiver does set limits to the number of patients to whom a provider can prescribe buprenorphine, but the training course is free and providers can complete it at their leisure, notes psychiatrist Michael Mancino, MD, program director of The Psychiatric Research Institute’s Center for Addiction Services and Treatment (CAST) at the University of Arkansas for Medical Sciences (UAMS).
“That is not a significant barrier,” he says.
Nurse practitioners, PAs, and other advanced practice nurses can get waivers, too. They must complete 24 hours of training, or they can also take the same free eight-hour training that physicians take, plus an additional 16 hours of training from SAMHSA.
In Arkansas, the number of providers with waivers has grown from 85 to more than 300 over the past few years, according to Mancino. But he says the waiver isn’t the biggest hurdle standing in the way of people gaining access to more waiver-trained clinicians.
“The number one barrier in Arkansas is stigma,” says Mancino.
He explained that some clinicians don’t believe that addiction is an illness, thought it should be treated as such. Instead, some still view addiction to opioids (or other substances) as a moral failure or lack of willpower.
Zare agrees that the mindset needs to shift. “Substance use disorder is a chronic disease,” he says. “We don’t stigmatize someone who has hypertension, we manage it chronically. We need to take patients with substance use disorder and treat them the same way.”
What else is needed?
A recent study in the journal Drug and Alcohol Dependence examined the disparity between opioid overdose deaths and available treatment services in Flint, MI. The researchers found that opioid treatment centers were rarely located in the areas where the most overdose deaths occurred.
That’s critical information because it shows where the greatest need lies and illustrates a geographical barrier for people who may want to access treatment but can’t, according to researcher and epidemiologist Deborah Furr-Holden, PhD, associate dean for public health integration at Michigan State University and director of the Flint Center for Health Equity Solutions.
The study also illustrates the need for more healthcare professionals who are specialists in in addiction medicine, says Furr-Holden. A generalist with waiver training can be helpful, but having an adequate number of experts with the specialized training and experience is really critical.
“Do you want an orthopedist delivering your baby?” Furr-Holden says. “You want somebody who’s trained. Treating addiction isn’t something that we can just make up as we go along.”
“Our training and medical education needs to catch up to the problem,” she says.