The Biden administration doesn’t need Congress to make permanent rules for virtual opioid treatment, … [+]
A key treatment for opioid addiction will become harder to prescribe once temporarily rules for telehealth expire, but a new report says that the Biden administration can make the change permanent without Congress.
To prevent the spread of Covid-19, in March 2020, the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) relaxed prescribing rules for opioid treatment programs and specially trained providers, including allowing providers to prescribe buprenorphine, one of three “gold standard” drugs for opioid use disorder, during a telehealth visit without first holding an in-person exam. The change made it easier for patients suffering from opioid use disorder to begin care regardless of where they lived. Opioid treatment programs are especially scarce in rural areas despite more than tripling from 1999 to 2015. Without the new ease of prescribing buprenorphine, fewer people would have been able to access treatment in 2020, when opioid overdoses rose 29% compared to the previous year, which had been the deadliest on record.
The authority to loosen the rules is pegged to the Secretary of Health and Human Services’ declaration on a public health emergency, first made in January 2020, which in line with federal law has to be renewed at least every 90 days. When the emergency declaration is allowed to expire, opioid treatment providers will no longer be able to prescribe buprenorphine through telehealth without an in-person exam first. (The current emergency declaration ends April 7.) In September, before one such renewal of the public health emergency, Beth Connolly, a project director of the Substance Use Prevention and Treatment Initiative at the Pew Charitable Trusts, spoke of the anxiety providers faced over the potential that the rules would be allowed to change to their stricter predecessors overnight. “There is no bridge that we’ve seen or that we know of,” Connolly said at the time. “Providers are nervous.”
Congress can pass legislation making the changes permanent, but the body is currently absorbed in passing President Joe Biden’s proposed $1.9 trillion proposal for economic stimulus and funding to address the pandemic. But the administration does not have to wait for Congress to act, according to a report released Tuesday by researchers at George Washington University. Reviewing DEA and SAMHSA regulations, they wrote that the agencies have authority under a 2008 law which, while written to crack down on unscrupulous online pharmacies, has been applied to “[force] legitimate telemedicine providers to first conduct in-person medical evaluations” that make it harder for patients to get treatment,” according to the researchers. But the same law, they argue, provides the authority for the DEA and SAMHSA to write new regulations that make permanent the temporary telehealth rule allowing buprenorphine to be prescribed without an in-person exam. The agencies could also create a new registration program to regulate providers using telehealth to prescribe the medication. If regulators choose neither permanent approach, a third option remains, researchers write. Even when the Covid-19 pandemic is over, and with it the public health emergency declaration, there is another public health emergency declaration: The opioid crisis itself was declared a public health emergency in 2017, and has been renewed regularly ever since.
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