On Oct. 4, 2018, ACEP participated in a meeting along with 10 other provider groups to discuss with top officials of the Trump administration challenges they have had with providing buprenorphine as MAT. In attendance were the Surgeon General, Vice Adm. Jerome Adams, MD, MPH; Drug Enforcement Administration (DEA) Assistant Administrator John J. Martin; White House Office of National Drug Control Policy Acting Director James Carroll; HHS Assistant Secretary for Health Adm. Brett Giroir, MD; Assistant Secretary for Mental Health and Substance Abuse Eleanor McCance-Katz, MD, PhD; and Chief Medical Officer for the Office of the Assistant Secretary for Health, Vanila Singh, MD, MACM. ACEP member Reuben Strayer, MD, and ACEP Washington, D.C., staff participated on behalf of ACEP.
The provider groups shared the barriers they face in prescribing buprenorphine, including those brought by the X-waiver and training process; they offered suggestions for regulatory solutions. The senior administration officials were particularly interested in discussing the 72-hour rule, which allows emergency physicians to administer buprenorphine without being waivered, but requires patients to return to the emergency department for each 24-hour dosage, up to a maximum of three days. The officials concluded the meeting with commitments to examine potential regulatory approaches to add flexibility to the 72-hour rule as well as to provide DEA agents with additional training to ensure their enforcement efforts are appropriate and sensitive to patient needs.