Bipartisan Bill Aims to Expand OUD Medication Access via Telehealth

A bipartisan group of four senators reintroduced legislation that would eliminate barriers to the virtual prescription of medication for opioid use disorder (OUD).

Called the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act, the bill would permanently extend telehealth prescribing flexibilities enacted during the COVID-19 public health emergency (PHE). This would waive the requirement for healthcare providers to conduct an in-person examination before prescribing medication like buprenorphine via telehealth for OUD patients.

The United States Drug Enforcement Administration (DEA) recently extended this flexibility through 2024. However, the TREATS Act would permanently extend virtual access to OUD treatment.

US Sens. Sheldon Whitehouse (D-RI), Lisa Murkowski (R-AK), Mark Warner (D-VA), and Marsha Blackburn (R-TN) reintroduced the bill to support expanded healthcare access amid the ongoing opioid crisis.

“The opioid epidemic has taken a devastating toll on Rhode Island families from all walks of life,” said Whitehouse in a press release.  “During the depths of the COVID-19 pandemic, telehealth sessions were a lifeline for those walking the long road to recovery while dealing with stress and isolation. Our bipartisan legislation would make telehealth flexibilities permanent to ensure that lifesaving recovery support continues to be widely available from the comfort of home.”

Drug overdose deaths doubled from 52,404 people in 2015 to 106,000 in 2021, according to data from the Centers for Disease Control and Prevention (CDC). National overdose deaths involving any opioid totaled 80,411 in 2021, and overdose deaths involving prescription opioids reached 16,706.

To combat the opioid epidemic, healthcare providers are leveraging numerous strategies and tools, including widening access to telehealth.

According to a study published in 2022, the expansion of telehealth use during the pandemic was associated with increased use of medications for OUD treatment and reduced odds of medically treated overdoses.

Further, recent research shows that Medicaid beneficiaries in Kentucky and Ohio who started buprenorphine treatment through telehealth were more likely to stay in treatment longer compared to those starting treatment in a non-telehealth setting.

Thus, several professional organizations have endorsed the new bill, including the American Medical Association, American Society for Addiction Medicine, American Telemedicine Association, National Rural Health Association, National Association of Addiction Treatment Providers, and The Pew Charitable Trusts.

“Telehealth access to buprenorphine has transformed opioid use disorder treatment, as patients haven’t had to take off work, find transportation or child care, or face the stigma that often accompanies in-person treatment,” said Brandee Izquierdo, director of behavioral health programs for The Pew Charitable Trusts, in the press release. “The TREATS Act will help more patients receive treatment by permanently allowing them to access this lifesaving medication remotely.”

The virtual prescribing of controlled substances has been a hotly debated topic this year.

In February, the DEA issued a proposal to permanently extend some pandemic-era telehealth rules governing virtual prescribing while ending others. The agency stated that it would safeguard providers’ ability to remotely prescribe a 30-day supply of Schedule III-V non-narcotic controlled medications, including buprenorphine for opioid use disorder (OUD) treatment, without a prior in-person exam. But, this flexibility would not extend to Schedule II controlled substances.

Healthcare providers and telehealth stakeholders vehemently pushed back against this proposal.

 At a DEA listening session in September, Shabana Khan, MD, chair of the American Psychiatric Association's telepsychiatry committee, raised concerns regarding the DEA's plan, noting that the 30-day initiation "would not be adequate given the current wait times, given the [physician] shortages…”

Following the listening sessions, the agency announced it would extend the pandemic-era flexibilities for the virtual prescription of controlled substances through the end of 2024.