ACEP Helps Get 3-Day Bupe Rule Changed to Improve Patient Care

December 12, 2020

As part of the stopgap funding bill approved by Congress late last week, emergency physicians, who do not have a U.S. Drug Enforcement Administration (DEA) X-waiver, will now be able to dispense, from the ED, up to a three-day supply of buprenorphine at one time to a patient suffering from acute withdrawal symptoms.

The funding bill included the "Easy Medication Access and Treatment for Opioid Addiction Act" (Easy MAT Act), H.R. 2281, which ACEP has been working on with Congressman Dr. Raul Ruiz (D-CA) since last year.

The previous “Three-Day Rule” enabled emergency physicians to initiate buprenorphine treatment of opioid use disorder (OUD), but patients had to return to the ED within the 72-hour window to receive additional doses while they awaited arrangements for long-term treatment.

Because many patients have difficulty coming back to the emergency department each day for a variety of reasons, this becomes a barrier to patient care and providers could be less likely to initiate treatment. With the ability to give three days of medication at one time, patient care is improved.

Emergency physicians will be able to dispense buprenorphine without an X-waiver, as long as it’s just a three-day supply. However, emergency physicians will still need an X-waiver to prescribe buprenorphine for the patient to access outside of the ED post-discharge. (ACEP continues to advocate to change this rule as well.)

Through the tenacious work our ACEP’s leaders, D.C. staff and many of our members, this important change will ensure that patients suffering from opioid use disorder get the necessary treatment, and that emergency physicians have the flexibility and resources needed to do their jobs.

The DEA will need to revise regulations within 180 after the bill is signed into law. More details about the Act can be found here.

ACEP has been working on this issue for several years. ACEP leaders and members of the D.C. staff have met with the Substance Abuse and Mental Health Services Administration (SAMHSA) and HHS multiple times and have included a specific request to change the three-day rule in numerous letters to the administration and to Congress.

In March 2018, now-ACEP President Dr. Mark Rosenberg testified before the House Energy and Commerce Committee about the importance of ED-initiated MAT programs and ACEP has been working with Dr. Ruiz’s office on this three-day waiver legislation (H.R. 5770) since it was first introduced in May 2018.

ACEP supported Dr. Ruiz’s legislation and efforts to get it included in what became the “SUPPORT for Patients and Communities Act” (where the ALTO and the POWER Act were authorized), but Dr. Ruiz ultimately withdrew his bill as an amendment during the mark-up process.

However, Dr. Ruiz, with ACEP’s support, reintroduced the bill (H.R. 2281) in this Congress (April 2019). ACEP also supported the legislation when Dr. Ruiz successfully brought it before the House Energy and Commerce Committee for approval on Sept. 9, 2020 and then again when the House approved the bill on Nov. 17, 2020.

Before the House voted on the bill, ACEP facilitated a call between the ACEP D.C. staff, ACEP member Dr. Eric Ketcham, and the Congressional Budget Office to promote the legislation and help them develop the financial implications to the federal budget, a necessary step so it could be brought up for consideration.

Read more about ACEP’s advocacy work on this issue in the Regs and Eggs blog from May 2020.