A new study finds that allowing health care providers to prescribe buprenorphine—an FDA-approved medication for opioid use disorder (OUD)—remotely during the COVID-19 pandemic helped more patients start and stay in treatment without increasing overdose deaths. Researchers from George Washington University’s Regulatory Studies Center and from New York University, with support from Pew, examined published research on how this pandemic-era flexibility affected outcomes in order to help federal policymakers determine how to best regulate buprenorphine access moving forward.
Prior to the COVID-19 outbreak, federal law required health care providers to see patients in person before prescribing buprenorphine. To encourage physical distancing during the pandemic, in March 2020 the Drug Enforcement Administration (DEA) allowed providers to prescribe the medication remotely, either via an audio or video appointment.
The DEA allowed this remote access under the COVID-19 public health emergency, which the Biden administration recently announced will end on May 11. Researchers reviewed 41 studies exploring patient and provider experiences with telehealth treatment, as well as how telehealth changed access to treatment and health outcomes. The study was published in medRxiv, an online archive and distribution server for health science manuscripts that have not yet been published in a peer-reviewed journal.
Study shows benefits for patients, providers with minimal downsides
The researchers found that many health care providers and patients took advantage of the telehealth option, with remote visits rapidly increasing for patients both beginning and continuing buprenorphine treatment, and that both patients and providers benefited from remote access.
A broader pool of patients was able to access virtual care. Veterans, people experiencing homelessness, individuals involved in the criminal justice system, those living in rural areas, and racial and ethnic minorities were all found to have greater access to buprenorphine via telehealth. Importantly, audio-only visits were critical to helping many of these patients access care.
As one psychiatrist noted, “I have a lot of patients who will never want to go back … A lot of people don't have transportation, gas money. We live in a rural area, so it's hard. I have patients that drive an hour to come and see me, so it's easier to just put up their camera versus driving an hour [here] and an hour back. So, it's definitely been more convenient.”
Patients were more satisfied receiving remote health care than in-person care. Patients noted that with telehealth, geography or transportation issues no longer limited their ability to receive treatment, and that virtual visits felt more comfortable and less stigmatizing than in-person care. They also said that having a choice in how they received care was important, and that remote access helped foster self-empowerment and mutual respect between providers and patients.
Providers were similarly satisfied caring for patients via telehealth. Many clinicians noted that their patients were more engaged and better able to adhere to treatment, and that by getting a glimpse into the home lives of their patients, they were better able to understand them. Some providers also felt better able to engage new patients in treatment, because they could start when patients felt ready.
Conversely, some patients expressed concern at the loss of in-person interaction with their providers, and others reported unjust treatment from provider staff and bureaucratic barriers when picking up the medication at a pharmacy. Providers experienced similar challenges with pharmacy dispensing, and others noted that they were uncomfortable caring for new patients remotely. Some providers also said they were hesitant to prescribe buprenorphine remotely given the temporary regulatory flexibilities, and others were worried about reimbursement issues related to remote prescribing.
The future of buprenorphine treatment
Patients and health care providers overall benefited from remote access to buprenorphine during the pandemic, and many providers expressed their hope that telehealth prescribing will continue. But the DEA recently issued proposed regulations that would limit remote access to buprenorphine and force patients to return to in-person treatment when the COVID-19 public health emergency ends in May.
Limiting access to a lifesaving medication when the U.S. is experiencing a record number of opioid-related overdose deaths per day will only harm patients and lead to more lives lost. No evidence supports the DEA’s proposal, which would only allow patients to receive a 30-day supply of buprenorphine remotely before they would need to see a health care provider in person to continue treatment. This study illustrates that virtual access to buprenorphine was essential to helping patients start and stay in treatment, and policymakers shouldn’t take that access away.
The DEA has the legal authority to continue allowing health care providers to prescribe buprenorphine to patients remotely, and come May, their final regulations should reflect that.
Marcelo Fernández-Viña works on The Pew Charitable Trusts’ substance use prevention and treatment initiative.