Pandemic-era changes increased access to Medication for OUD (MOUD) through Telehealth.
The results are profound.
We can’t turn back now. Tell Congress to protect access to Telehealth for OUD patients.
On May 10, the Drug Enforcement Administration (DEA) in conjunction with Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary rule, effective May 12, to allow the following:
The COVID-19 Public Health Emergency came to an end on May 11th as planned.
As you may know, during the COVID public health emergency, Medication for Opioid Use Disorder (MOUD) treatment became accessible to patients through telemedicine under a temporary waiver of the Ryan Haight Act. Unfortunately, the Act’s restrictions become active again on May 11 unless some things change.
That is why the DEA has proposed new rules. While the DEA rule does create a permanent exception to the Ryan Haight Act that allows MOUD treatment via telemedicine to continue, the rule needs to be modified in order to protect patient health and safety.
What Does the Rule Do?
In its current draft, the new rule requires that by November 2024, patients already receiving treatment have to complete an in-person visit with a medical provider and get a referral back to telemedicine if they want to stay in treatment.
This “in-person visit” requirement also applies to new patients, but new patients only have 30 days to complete an in-person visit and get a referral before their prescription runs out.
What’s the Medical Justification for an In-Person Visit?
There is no medical evidence that justifies this in-person requirement. It is medically unnecessary, it increases costs, inconveniences patients, and has no offsetting benefit.
There is, however, ample peer-reviewed research that highlights the potential harm this rule could create, if enacted.
What Should Concern Lawmakers about the DEA's Proposed Rule?
Doctor-Patient Relationship Concerns: For patients with opioid-use disorder who have established relationships with a telemedicine provider, how does it benefit their recovery to require a new provider’s approval to continue that relationship?
Impact on Quality & Outcomes of TeleOUD Treatment: Ample research has shown that allowing access to buprenorphine via telemedicine, during the pandemic, reduced the rate of opioid-related overdoses, ER visits and deaths, and did not increase the rate of buprenorphine misuse. How will making the process more difficult improve patient outcomes?
Access to Specialists in Addiction Medicine: Addiction medicine is a high-demand specialty. Telemedicine democratizes access to these specialists, so what is the value of making a general practitioner with little or no expertise in addiction medicine a gatekeeper to this form of specialty care?
Cost of Care: The DEA’s proposed rule ignores the cost to patients of having an additional in-person exam, the cost of transportation, childcare, time off of wor, and how those impact a person in recovery. Would the in-person requirement disproportionately impact access to care for lower-income patients who already struggle to afford care?
No Accounting for Emergencies: If a patient or provider misses a scheduled in-person appointment for any reason and the appointment can’t be rescheduled within the 30 day window, the proposed rules don’t permit exceptions for any reason. Understanding that people with OUD have a high likelihood of relapse, overdose and death if their medication runs out, is this reasonable?
Lack of Benefit of In-Person Visit: There is no evidence to support the DEA’s assumption that in-person care is more thorough than telemedicine. There is evidence that telemedicine care is more effective than in-person for most patients with OUD. The new rules mandate a less effective form of care, from a generally less specialized provider, with no evidence of benefit to offset the expense and potential harm. Why?
No Evidence of Diversion: The data is clear that buprenorphine-involved deaths did not increase despite wider access to telemedicine OUD care during the pandemic, according to research published in JAMA in January of 2023. Can DEA support their assumption in the rule that telemedicine increases risk of diversion or misuse of buprenorphine?
Increased Risks to Patient Health: There is ample research showing that patients who stop buprenorphine for OUD after just 30 days return to opioid use. One example is this 2009 study that showed 87 percent of OUD patients who tapered off of buprenorphine over a 28-day period returned to other opioid use within just three months.
Rationale for 30-Day Prescriptions: The medical rationale to only permit certain patients who meet the in-person requirement to continue treatment beyond 30 days does not exist. If treatment beyond 30 days is recommended for everyone, why should this arbitrary 30-day limit be imposed?
Risks of a 30-day Prescription: A 2011 study found 93 percent of OUD patients who completed a 4-week course of buprenorphine treatment returned to active opioid use. Should the DEA provide a medical rationale for putting a patient’s health at risk by limiting their prescription to 30 days without an in-person visit?