During the COVID-19 pandemic, remote prescribing of buprenorphine—an FDA-approved medication for opioid use disorder (OUD)—dramatically reduced barriers to lifesaving treatment for many individuals, including those living in rural areas, racial and ethnic minorities, people experiencing homelessness, veterans, and those with criminal justice system involvement. And for the first time, patients were able to access buprenorphine through an audio-only, or telephone, connection. Although the Drug Enforcement Administration and Substance Abuse and Mental Health Services Administration have the legal authority to temporarily extend the COVID-19 telehealth flexibilities and have done so temporarily through Dec. 31, 2024, the agencies should make these flexibilities permanent.
Alternatively, Congress is considering legislation that could more immediately allow patients to permanently receive buprenorphine treatment remotely. These two bills, which Pew urges Congress to pass, would do the following:
Waive the in-person requirement for prescribing buprenorphine
Transportation challenges and child care responsibilities can make it hard for people to make it to their appointments to get substance use treatment in person. Physician shortages and long wait times for new patients can also reduce access to in-person treatment, especially for patients who have Medicaid or lack insurance. The bipartisan Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act (H.R. 5541/S. 3193) would permanently authorize patients to start buprenorphine through an audio-only or audio-video telehealth appointment.
Make audio-only flexibilities permanent
In addition to the challenges people face for in-person substance use treatment such as limited transportation, decreased mobility, and caregiving responsibilities, lack of access to technology like smartphones and the internet and difficulty with audio-video technology can create significant challenges that can be addressed only by audio-only buprenorphine treatment. Passage of the TREATS Act would permanently allow patients to start buprenorphine through an audio-only or audio-video telehealth appointment.
Audio-only buprenorphine initiation is feasible, safe, and effective and is clinically comparable to audio-video initiation, providing reliable access to treatment for many patients, especially those already facing access challenges. Pew has also recommended changes to the Centers for Medicare and Medicaid Services’ current definition of telecommunications systems to allow for Medicare payment of audio-only services.
Continue to allow patients to receive care from their homes and other sites
Patients have cited transportation, caregiving responsibilities, and stigma as challenges to accessing substance use treatment outside their homes. Older Americans represent an increasing share of individuals experiencing OUD, but Medicare can pay only for telehealth services that patients receive in their homes or other sites through the end of 2024, when legislation that extended Medicare telehealth payment expires.
The bipartisan Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (H.R. 4189/S. 2016) allows Medicare to pay for telehealth services patients receive in their home or other sites by making them originating sites, or allowable locations for them to receive telehealth services, and removes geographic requirements.
The evidence is clear: Allowing providers to prescribe buprenorphine remotely during the pandemic helped more patients start and stay in treatment without increasing overdose deaths. Being able to access buprenorphine via telehealth has empowered patients and reduced patient access challenges related to transportation, caregiving, and stigma. Providers have noted that prescribing buprenorphine via telehealth has led to better patient engagement and treatment adherence and has afforded unique insights into patients’ home lives.
Lawmakers should pass the bipartisan TREATS and CONNECT acts to advance telehealth for treatment of OUD.
Marcelo Fernández-Viña works as an officer on Pew’s substance use prevention and treatment initiative.
Sheri Doyle, now a senior officer with The Pew Charitable Trusts’ public health data improvement project, previously worked as a senior manager on the substance use prevention and treatment initiative.