Viewpoint: Telehealth Access for Opioid Use Disorder Treatment is Needed

Published in Health Affairs, a new viewpoint article emphasized the prevalence of opioid use disorder (OUD)-related deaths and how regulatory actions are needed to ensure access to virtual care for OUD following the COVID-19 public health emergency (PHE).

According to the Centers for Disease Control and Prevention (CDC), almost 69,000 people died from overdoses involving opioids in 2020.

Amid the prevalence of OUD-related issues, the COVID-19 pandemic spurred changes to legislation surrounding the treatment of this condition. Pre-pandemic, there was a requirement for an in-person visit before controlled substances could be prescribed virtually. However, the COVID-19 PHE led to the suspension of this prerequisite. Despite the existence of this flexibility for the last three years, it will end on May 11, with the end of the PHE declaration.

This led Stephen A. Martin, MD, a professor of family medicine and community health at the UMass Chan Medical School and healthcare practitioner at the Barre Family Health Center, and Arthur Robin Williams, MD, assistant professor in the department of psychiatry's division on substance use disorders at Columbia University and a research scientist at New York State Psychiatric Institute, to question whether access to OUD treatment will be sufficient in the future.

In the article, they noted that the US Department of Health and Human Services (HHS) eliminated certification requirements for clinicians to provide buprenorphine for up to 30 patients in April 2021. A December 2022 report from HHS indicated that buprenorphine prescriptions did not increase following the regulatory change despite an increase in clinicians approved to prescribe the medication.

Martin and Williams noted that though their telehealth companies reportedly cared for more patients during the pandemic, they are leaning toward pausing growth due to a lack of clarity regarding future regulations.

The Drug Enforcement Agency (DEA) has announced a post-PHE proposal that could hinder access to OUD medication. Known as “Expansion of Indication of Buprenorphine via Telemedicine Encounter,” the potential law requires a qualified referral or an in-person visit within 30 days of a telehealth-initiated buprenorphine prescription. According to the article, obtaining a primary care visit as a new patient or a Medicaid beneficiary within this timeframe would be difficult.

Martin and Williams stated that addressing the OUD crisis requires attention and responsiveness, which telehealth can enable.

Due to this, they noted that the DEA solidifying telehealth allowances would lead to positive outcomes, as data from the last three years show.

Several healthcare organizations have spoken out about the DEA's proposal to end flexibilities for virtual prescriptions.

In March, a group of healthcare trade associations, mental healthcare organizations, and providers noted concerns surrounding the proposed rules from the DEA regarding telehealth-based prescribing.

The groups stated that the rules would limit access to care and adversely impact marginalized groups.

For example, Kyle Zebley, executive director of ATA Action, the advocacy arm of the American Telemedicine Association, noted in a letter, "There is an ever-increasing number of patients who cannot or will not seek treatment for their conditions in person. These are the patients who will fall through the cracks under this rule, creating a significant and avoidable public health crisis."