Telemedicine & Initiating Buprenorphine Treatment

Report I of the Extending Pandemic Flexibilities for Opioid Use Disorder Treatment Project

February 23, 2021

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Extending Pandemic Flexibilities for Opioid Use Disorder Treatment

This report is the first in a project supported by The Pew Charitable Trusts. Our second report will be published later this year, and will be available on our project landing page along with related content.

 

Executive Summary

Federal regulators dramatically reduced the barriers to using telemedicine to treat opioid use disorder in response to the COVID-19 public health emergency. Public health experts have long argued that health care practitioners can provide high-quality treatment for opioid use disorder via telemedicine. Until now, federal regulation has limited the ability of practitioners to prescribe buprenorphine, one of the medications considered the gold standard for treatment of opioid use disorder, using telemedicine.  

Regulations limiting telemedicine, rooted in concerns about diversion of controlled substances, restrict practitioners from treating patients. This has particularly troublesome effects for patients located in geographic areas facing a shortage of practitioners because it further restricts the available pool of practitioners. The Drug Enforcement Administration (DEA) stated that after the COVID-19 public health emergency, telemedicine will return to the way it was before the emergency because the law requires it. Practitioners and public health experts are concerned that this would erode access to treatment. Congress could certainly make this change permanent using legislation. Setting that possibility aside, this report provides an independent assessment of whether DEA and the Substance Abuse and Mental Health Services Administration (SAMHSA) have the legal authority to extend the flexibilities after the public health emergency ends.  

This report concludes that DEA and SAMHSA have the legal authority to extend the flexibilities granted during the COVID-19 public health emergency without additional authorization from Congress. DEA and SAMHSA have the authority to jointly issue regulations allowing practitioners to prescribe buprenorphine without first conducting an in-person medical evaluation. As an alternative, DEA can use its authority to establish a special registration for telemedicine program while SAMHSA issues an associated policy. As another alternative, SAMHSA and DEA can use the opioid-specific public health emergency declaration to offer a longer term, but not permanent, option to extend these flexibilities. 

View Related Content: Extending Pandemic Flexibilities for Opioid Use Disorder Treatment

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Options to extend COVID-19 flexibilities beyond the pandemic to help treat opioid use disorder.

Extending COVID-19 Flexibilities

Options for DEA and SAMHSA to extend regualtory reforms beyond the pandemic.

 


 

Graphic of pharmaceuticals that treat opioid use disorder: Naltrexone, Buprenorphine, and Methadone.

Treatments

Buprenorphine is one of the gold standard treatments.

From 2014 to 2016, Wyoming County West Virginia had the highest overdose rate in the state and possibly in the country.

Wyoming County

This county has the highest overdose death rate.

Graphic explaining agency responses to the COVID-19 pandemic related to treating opioid use disorder.

COVID-19 Response

Actions taken by SAMHSA and DEA.

Facts about the Substance Abuse and Mental Health Services Administration (SAMHSA).

SAMHSA

Substance Abuse and Mental Health Services Admin.

 


 

Facts about the Drug Enforcement Administration (DEA).

DEA

Drug Enforcement Administration

Key legislation related to opioid use disorder treatments: Ryan Haight online Pharmacy Consumer Protection Act of 2008, Drug Addiction Treatment Act of 2000, and the Narcotic Addict Treatment Act of 1974.

Key Legislation

Including the Ryan Haight Act of 2008.

Public health experts have long argued that practitioners can provide high-quality treatment for opioid use disorder via telemedicine.

Telemedicine

Federal regulations limit practitioner abilities.

As of 2018, there were 1,605 opioid treatment programs in the U.S., or one treatment program for every 205,000 Americans.

Treatment Programs

There is approximately one for every 205,000 Americans.