This article was updated April 8, 2020, to clarify that providers may meet with patients via telephone or video conference before initiating buprenorphine treatment.
The coronavirus pandemic has rapidly created health care challenges worldwide. Typically, for example, people with opioid use disorder (OUD) have to check in frequently with health care providers in person to get needed treatment, a process in conflict with calls for social distancing. The federal government, however, moved swiftly to ease restrictions around this treatment, making changes enabled by the public health emergency declaration that went into effect on Jan. 27.
Now states must do their part by ensuring that state and local regulations are not impeding the application of these new guidelines.
Such changes to procedures are essential to limit in-person contacts. Under long-standing rules, most OUD patients receiving methadone—one of three FDA-approved medications to treat the disorder—must take daily trips to opioid treatment programs (OTPs) to receive the drug. But public health officials are encouraging people to stay at home as much as possible to reduce the chance of exposure to the novel coronavirus. Recognizing this situation, the Substance Abuse and Mental Health Services Administration (SAMHSA) is allowing patients to take home treatment courses of two weeks or longer of methadone, helping to reduce the opportunity for a patient or practitioner to be exposed.
To begin treatment for OUD with buprenorphine, another OUD medication, federal rules have required an initial in-person consultation. The Drug Enforcement Administration (DEA) has suspended enforcement of that requirement, allowing providers to meet with patients via telephone or over video conference before prescribing.
In-person counseling in conjunction with medication is part of many treatment plans and is required of OTP patients. To further protect patients and providers, the DEA is permitting the use of telehealth options for counseling, and the Centers for Medicare and Medicaid Services is expanding reimbursement of telehealth services so that this option is easier to use. Using video or telephone calls allows patients to receive counseling in a manner that is safe for both them and their practitioners.
States and municipalities need to examine their procedures to make sure these changes are implemented smoothly. They should:
- Relax stringent take-home medication policies at OTPs by facilitating exceptions from SAMHSA requirements so that patients can travel less frequently and mitigate potential coronavirus exposure.
- Issue guidance to providers that encourages them to take advantage of flexible methadone dosing for stable patients (who may be further along in their recovery and have steady living situations), alternative dosing strategies for less stable patients, and home delivery for quarantined patients.
- Re-evaluate policies around how patients can enter into treatment.
- Simplify licensing rules to allow more practitioners to provide services through telehealth, such as allowing the use of private video chat applications to talk to patients, even if the apps are not technically compliant with the Health Insurance Portability and Accountability Act. Known as HIPAA, the law sets rules for medical providers on patient privacy and data security.
- Allow for reimbursement of services provided via telehealth.
- Allow for reciprocal treatment agreements between states so that telehealth patients can be treated across state lines, to increase the availability of services.
The U.S. health care system is under immense strain as it grapples with the coronavirus pandemic. Where states have the ability, they should give providers the tools and authorities they need to ensure that people with OUD can get needed care without putting themselves at unnecessary risk.
Beth Connolly directs The Pew Charitable Trusts’ substance use prevention and treatment initiative.