The Oct. 8 op-ed by Dr. Jeremy Samuel Faust and Cass R. Sunstein (“Cut the bureacratic sludge”) explores the detrimental effects of “stifling administrative burdens” on medical care, notably for opioid addiction. They focus on the lack of access to the current treatment standard of medication-assisted treatment and offer some ways to tinker with the existing system. They don’t go far enough.
The real bureaucratic “sludge” here is the continuance of the Harrison Narcotics Tax Act of 1914. This act, regulating the interstate commerce of opioids, also prohibits physicians from prescribing narcotics in their professional practice to people with opium addiction. This interpretation of the statute was upheld, 5 to 4, by the Supreme Court in 1919, under Webb v. United States. Physicians were arrested and imprisoned for prescribing opium.
As a consequence of the Harrison Act, the medical profession essentially turned its collective back on patients suffering from severe pain or addiction for over a century. This situation continues to this day. Nine out of 10 opioid-addicted people in this country do not have access to medication-assisted treatment.
There have been important strides: the advent of methadone treatment in the late 1960s, and confirmation by fMRI (functional magnetic resonance imaging) in the early 2000s that addiction is a brain disease. There are now licensed medical specialties in both addiction and pain medicine. The federal government should allow qualified health professionals, already licensed to prescribe opioids, to provide medication-assisted treatment for opioid addiction without the “sludge” of special waivers and licenses, whether for buprenorphine or methadone.
Repeal the Harrison Act now.
Dr. Henrietta Robin Barnes
Jamaica Plain
IN IDEAS: Free-trade policies have contributed to the opioid epidemic