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The History of the Waiver

By November 16, 2019Uncategorized

As numbers continue to rise in Opioid Use Disorder (OUD) related deaths, it is important to take a look back at what possible historical landmarks might have made an impact on the current opioid crisis in the United States. Various laws in the early 1900s , such as the Harrison Narcotics Tax Act, aimed to regulate the spread of opiates and cocaine in the United States1. This act, made effective in 1914, allowed physicians to prescribe only in ‘professional practice’. 2 Another major effort to regulate drug distribution and use occurred in 1920, in the court ruling of Jin Fuey Moy v. United States. It ruled that a physician could not provide opiates for patients to ‘satisfy a craving’. 

These almost more than a century old ruling affects how providers can prescribe partial agonists, such as buprenorphine, for treatment reasons, but has minimal restrictions when prescribed for pain relief purposes. It was not until the Narcotic Addict Treatment Act of 1974 that doctors were permitted to treat patients with OUD, after obtaining a specialized certification. Another change came about at the beginning of the 21st century when the Drug Addiction Treatment Act of 2000 (DATA2000) opened an easier path for providers to prescribe buprenorphine/naloxone. DATA2000 opened doors for physicians to obtain a ‘waiver’ in order treat OUD patients in any healthcare facility.

Joseph W. Frank, Sarah E. Wakeman & Adam J. Gordon (2018) No end to the crisis without an end to the waiver, Substance Abuse, 39:3, 263-265, DOI: 10.1080/08897077.2018.1543382)