You work one shift in an emergency department, you see the holes in our health care system. There are many barriers to care: lack of insurance, lack of transportation, lack of housing and many others. Despite these challenges, one of the most gaping holes in our health care system is the lack of access to substance use treatment.

Every drug overdose is preventable. All patients treated in the emergency department after an overdose needed to be treated long before that life-threatening event. This experience continues to reinforce my belief that we must incorporate addiction medicine and harm reduction into primary care. When I left the emergency department to work as a nurse practitioner in a federally qualified health care center, I incorporated addiction treatment into my primary care practice.

Many primary care providers like me have tried to do the same but are stymied by regulations that make it difficult to treat substance use disorders. One such regulation is the “X waiver,” an onerous, outdated federal requirement for prescribing Buprenorphine. Buprenorphine is an effective medication for opioid use disorder that can prevent overdose death. Congress can remove the X waiver requirement by passing the Mainstreaming Addiction Treatment Act.

Buprenorphine effectively curbs cravings for people with opioid use disorder and significantly reduces the risk of overdose death. But since 2000, the medication has been subject to a burdensome training requirement for anyone who wishes to prescribe it.

I was not required to do any additional training to prescribe oxycodone or fentanyl, but had to complete training to prescribe Buprenorphine, a lifesaving medication. Upon completing this training, licensed providers operate under the so-called “X waiver” to prescribe controlled substances but are limited to 30 patients for the first year. Nowhere else in my practice am I limited to the same restrictions. There are no limits on the number of patients I can care for with diabetes, cancer or liver disease. These limits on prescribing Buprenorphine only further stigmatize opioid use disorder and prevent providers from meeting patients’ needs.

This requirement has resulted in a shortage of providers who can prescribe this life-saving medication. In 2020, the federal government found that 40% of U.S. counties lack a single health care provider who can prescribe Buprenorphine. In more rural parts of the U.S., like here in Maine, people looking for treatment have a harder time accessing effective medications.

It has also hindered the ability to provide immediate care to someone who needs it. In my first year under the X waiver, I was only able to treat 30 Buprenorphine patients at a time. If a 31st patient came to me, I had to deny treatment and try to connect them with a provider who had not hit their limit. That moment, when a patient confides in me about their substance use and desire to find recovery, only to be turned away – that is a hole in our health care system that continues to contribute to the ever-increasing rate of overdose deaths.

I’m a lifelong New Englander who has lived and worked in Maine for years, and I’ve grown to know a few things about the state I call home.

People outside of Maine are from “away” because we are a tightknit community filled with hardworking, resilient people. The overdose crisis has hit our community hard. Mainers with substance use disorders are our neighbors, siblings, parents, children and they are incredibly resilient too. And when they come to my clinic, they are looking for treatment and hoping for recovery. To fulfill that vision, we need Maine to be able to treat addiction comprehensively. The U.S. Senate can get us closer by passing the MAT Act, removing the X waiver, and providing Mainers in need with immediate access to Buprenorphine. We can’t let Mainers fall through the cracks anymore.

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