More than two years ago, just before Donald Trump was elected president, Demetra Ashley, associate deputy assistant administrator of the office of diversion control with the Drug Enforcement Administration (DEA), told the American Association for the Treatment of Opioid Dependence (AATOD) that new licensing regulations that would provide for more mobile vans to provide methadone and buprenorphine for opioid use disorders were in the works. She told the AATOD board the same thing a few months later, just before the inauguration. A year later, however, the discussion appeared stalled.
It still is.
“I was advised that new regulations can take years to be issued, because they not only have to go through internal DEA review but also interagency review, including both other federal agencies and White House offices, such as the Office of Management and Budget,” said Barbara L. Carreno, DEA spokeswoman, in an email to AT Forum in December. “These new regulations are one of our top priorities, on which we are working diligently,” she said. Her source (at diversion control) “did not know how close to coming out these regulations are,” she added.
Department of Justice Under Extreme Pressure
To be fair, the Department of Justice, DEA’s parent department, has been under extreme pressure lately, to put it mildly. Attorney General Jeff Sessions stepped down—in the face of being fired—on November 7, the day after the midterms. The entire department has been caught up in issues that are not related to methadone or the opioid crisis, but fortunately for patients with opioid use disorder, the Department of Health and Human Services has been giving the subject a lot of attention. The Substance Abuse and Mental Health Services Administration, which is headed by HHS, sent its mobile van recommendations to the DEA years ago. The issue is now in the DEA’s court, where it has been for some time.
The idea was to connect these mobile vans to existing brick-and-mortar opioid treatment programs. To that end, some states are spending federal grant money to purchase the vans, using them for outreach, with the hope that one day, the vans can actually transport medication. In some places of the country, this is already happening. But the federal regulations need to change if mobile vans are to be helpful on a widespread basis.
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