What’s the news: COVID-19 emergency era flexibilities that enabled physicians to prescribe medications for opioid-use disorder via telehealth will remain in place permanently thanks to a final rule published by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The regulation expands access to lifesaving medications for opioid-use disorder and aims to reduce stigma, marking important updates to the regulations that govern opioid treatment programs. Among other things, the final rule published in the Federal Register:
- Makes permanent COVID-19 public health emergency exceptions for opioid treatment programs that allowed treatments to be initiated through telehealth, including methadone via audio-visual telehealth technology and buprenorphine via audio-only and audiovisual technology.
- Makes permanent the flexibilities that expanded who was eligible to receive take-home doses of methadone.
- Enables treatment eligibility for patients with an addiction history of less than one year.
- Permits patients to start medication treatment while they wait for further services.
- Removes stigmatizing language and includes updated definitions so that they reflect current medical usage.
After a 60-day period from the publication date, the new rules will take full effect within this fall, giving opioid treatment programs time to prepare to implement changes. It remains important for policymakers to also extend the COVID-19 exceptions permanently for office-based physicians who prescribe buprenorphine to treat opioid-use disorder.
Why it’s important: “Cementing these policies is a step in the right direction in the fight against the worsening overdose epidemic to increase equitable access to care, reduce stigma of seeking treatment for opioid use disorder and embrace technology in medicine,” said Bobby Mukkamala, MD, who chairs the AMA Substance Use and Pain Care Task Force and serves on the AMA Board of Trustees.
“Prescribing buprenorphine through telehealth visits provides the opportunity to reach remote and underserved communities and patients who may be unable to travel daily to in-person appointments because of distance to the OTP [opioid treatment program], cost, childcare, employment and other factors,” said Dr. Mukkamala, a Flint, Michigan, otolaryngologist.
He was part of the Prevention, Treatment and Recovery Services Working Group of the National Academy of Medicine’s Action Collaborative on Countering the U.S. Opioid Epidemic. As part of that panel, Dr. Mukkamala was a co-author on a National Academy of Medicine discussion paper on strategies to prevent substance-use disorders.
The experience during the COVID-19 public health emergency showed that using telemedicine to prescribe controlled substances helped patients—those with and those without an in-person evaluation—to start and maintain necessary, evidence-based care for many medical conditions, including opioid use disorder.
For example, between September 2019 and February 2021, patients who were treated for opioid use disorder through telehealth had 33% lower adjusted odds of a fatal overdose than those who received no medication treatment, according to a 2023 study published in JAMA Psychiatry.
“While this rule change will help anyone needing treatment, it will be particularly impactful for those in rural areas or with low income for whom reliable transportation can be a challenge, if not impossible. In short, this update will help those most in need,” said SAMHSA Administrator Miriam E. Delphin-Rittmon, PhD.
Learn more: The AMA believes that science, evidence and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic evolves into a more dangerous and complicated illicit drug overdose epidemic. Explore further at the AMA’s End the Epidemic website.
Visit AMA Advocacy in Action to find out what’s at stake in ending the overdose epidemic and other advocacy priorities the AMA is actively working on.
Editor’s note: This story has been updated to emphasize that the rule changes apply only to opioid treatment programs, and the need to expand these flexibilities to office-based physicians too.
