HHS Proposes Rule to Continue Expanded Access to Virtual OUD Services

Through its Substance Abuse and Mental Health Services Administration (SAMHSA), the US Department of Health and Human Services (HHS) has proposed updates to federal regulations that would allow for the use of telehealth for treating opioid use disorder (OUD).

Overdoses have become an increasingly concerning issue across the country in the last several years. According to the Centers for Disease Control and Prevention (CDC), 107,000 Americans died from drug overdoses in 2021, an increase of 15 percent compared to the previous year.

The new proposal from HHS aims to address this issue by permanently expanding access to treatment for OUD implemented temporarily during the COVID-19 pandemic. Specifically, it would update federal regulations that encompass OUD treatment standards as a part of the HHS Overdose Prevention Strategy. This strategy supports President Joe Biden’s National Drug Control Strategy, the press release notes.

The proposed rule would allow Americans to receive 14-to-28 days' worth of take-home doses of methadone, as well as give providers the ability to initiate buprenorphine prescriptions using telehealth as part of opioid treatment programs (OTPs). Through its Notice of Proposed Rulemaking (NPRM) to change 42 CFP Part 8, SAMHSA aims to improve patient experiences within OTPs by expanding access to OUD treatment.

The proposal from SAMHSA also includes provisions to remove outdated language, such as "detoxification," and expand the definition of an OTP treatment practitioner to include any provider who is appropriately licensed to dispense or prescribe approved medications.

“These proposed updates would address longstanding barriers [to] treatment in regulations – most of which have not been revised in more than 20 years,” said Miriam E. Delphin-Rittmon, PhD, HHS assistant secretary for mental health and substance use and the leader of SAMHSA, in the press release. “I am committed to moving these forward as quickly as possible because we have heard from both providers [and] patients how urgent the need is for treatment.”

In addition, SAMHSA's proposed updates include changes to evidence-based practice, enhancing patient engagement approaches, and reviewing OTP accreditation standards.

Recent research shows that enabling telehealth prescriptions for OUD medications helped reduce the risk of overdoses during the pandemic.

A study published in September involved researchers conducting a review of data from the Centers for Medicare and Medicaid Services on adult beneficiaries with OUD. They divided data on OUD patients into two periods: before and during the COVID-19 pandemic.

Researchers found that the patients in the pandemic group had higher odds of remaining in programs that provide medications for OUD, along with a lower likelihood of medically treated overdoses.

Further, calls to make permanent the flexibilities surrounding the virtual prescribing of controlled substances have grown in recent months.

In November letter, a group of 45 attorneys general from various US states asked the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) to allow providers to continue virtually prescribing buprenorphine for OUD.

The request aimed to expand the treatment offerings for OUD amid the growing prevalence of the condition. The letter further noted that the expiration of virtual prescription capabilities would cut off about 2.5 million US adults from obtaining buprenorphine.