Senators Seek Telehealth Expansion for Substance Abuse Treatment

A new bill before the Senate aims to expand the telehealth platform for substance abuse treatment.

Introduced last week by Senators Rob Portman (R-OH) and Sheldon Whitehouse (D-RI), the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act would make permanent certain emergency actions passed during the coronavirus pandemic to boost telehealth access for substance use disorder (SUD) treatment.

While the bill’s text hasn’t yet been made public, it would reportedly include allowing care providers to skip the in-person exam requirement and prescribe controlled substances in Medicated Assistant Treatment (MAT) therapy programs via connected health. It would also expand Medicare coverage for mHealth services to include audio-only phone calls.

“The COVID-19 pandemic has affected every aspect of our lives and the increase in overdoses we’re seeing only increases the need for additional flexibility to help those suffering from addiction,” Portman said in a press release. “The roll out of telehealth waivers has both helped patients maintain access to care safely at home and increased access to care for those that didn’t otherwise have access to in-person treatment. As we move forward and look to life beyond this pandemic, we must make sure that the advances to care and access that telehealth is currently providing is not lost and that’s exactly what this bill will do.”

Mental health and substance abuse treatment providers have long lobbied the federal government to remove restrictions on virtual care for SUD treatment, clashing with those who argue that online prescribing needs to be tightly regulated. With substance abuse issues skyrocketing during the ongoing pandemic, federal officials have taken action to loosen those restrictions.

Under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, certain healthcare providers are allowed to prescribe controlled substances for treatment as long as they first conduct an in-person examination with the patient. That law offers several instances in which the in-person requirement could be waived. On March 16, the US Drug Enforcement Agency (DEA) waived that requirement by invoking the public health emergency exception caused by the COVID-19 crisis.

In addition, on March 19, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued separate guidance allowing Opioid Treatment Programs and certified care providers to use prescribed drugs and conduct treatments over the phone without first meeting in person. Shortly thereafter, the DEA joined SAMHSA in issuing a letter allowing “’authorized practitioners’ to prescribe buprenorphine to new and existing OUD patients for maintenance or detoxification treatment on the basis of telehealth examination, which may include a telephone voice-only evaluation - without the need for a prior in-person exam.”

“The DEA Letter allows authorized practitioners the added flexibility of using audio-only modalities (i.e., telephone) - instead of audio-visual, real-time, two-way interactive communication system - which is required to prescribe controlled substances via telemedicine, pursuant to the aforementioned emergency exception to the federal Ryan Haight Act,” Sunny J. Levine and Emily H. Wein of the Foley & Lardner law firm wrote in a recent blog summarizing the government’s actions.

Those emergency actions will end with the public health emergency, and telehealth advocates have been working at both the state and national level to extend many of these waivers indefinitely.

Among those supporting the TREATS Act are the American Society for Addiction Medicine, American College of Medical Toxicology, Kennedy Forum, National Association of Addiction Treatment Providers, National Association of Behavioral Health, National Safety Council, Shatterproof and the Well Being Trust.