45 State AGs Demand SAMHSA Action on Virtual Addiction Treatment

Forty-five state attorneys general have signed a letter asking the federal government to preserve COVID-era regulations for virtual addiction treatment.

The letter, which was organized by the National Association of Attorneys General (NAAG), was sent to the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA).

The letter specifically calls on SAMHSA and DEA to make good on an announcement it made in June. SAMHSA said it would allow opioid treatment programs (OTPs) to prescribe buprenorphine via telehealth after the end of the federal public health emergency. SAMHSA assigns OTPs their designation.


“Since this announcement, no actions have been taken to affirm this change,” the letter reads. “Today, the delivery of care for buprenorphine treatment has shifted significantly to telehealth, making it more accessible than ever for individuals to access the treatment they need.”

The long-running overdose death crisis in the U.S. has worsened since the pandemic. Deaths have increased by 42% following the pandemic’s onset. Advocates from several different groups have called for action at the federal level.

Virtual addiction treatment has bloomed during the pandemic and loosened regulations. Addiction treatment startups Quit Genius, Boulder Care, Ria Health, Bicycle Health and Brave Health have raised about $179 million since June.


In April 2020, SAMHSA exempted OTPs from the requirement to perform an in-person medical evaluation if telehealth provides adequate supervision. The exemption came in response to the federal PHE for the coronavirus.

The PHE has been renewed in 90-day intervals across the Trump and Biden administrations. Both administrations assured the public they would give 60 days’ notice that they would not renew the PHE.

Xavier Becerra, secretary of the U.S. Department of Health and Human Services (HHS), renewed the PHE on Oct. 13, which will now expire on Jan. 11, 2023. It should be expected to be renewed after then to keep with the Biden administration’s previous commitment.  

Among the five state AGs that didn’t sign onto the letter, some of them have taken moves to limit telehealth services. In Tennessee and Alabama, for example, out-of-state physicians may not practice via telehealth.

The NAAG isn’t alone in trying to goad the DEA and SAMHSA into action on virtual addiction treatment.

Earlier in the month, the American Telemedicine Association sent a letter to the DEA and U.S. Attorney General Merrick Garland to extend PHE-era prescribing flexibilities for controlled substances. Exactly 110 organizations signed on to the letter, including the American Psychiatric Association, Bicycle Health, Lifepoint Health and The Kennedy Forum, to name a new. 

Members of the House of Representatives Bipartisan Addiction and Mental Health Task Force got in on the action in October.

In a letter, Reps. Ann McLane Kuster (D-N.H.) and Lori Trahan (D-Mass.) wrote to  SAMHSA and the DEA asking the agencies to allow practitioners to start buprenorphine treatment via audio-only telehealth visits. They asked for a specific timeline for action. 

Advocates are also seeking greater flexibility for methadone. Like buprenorphine, methadone is used to treat OUD. Unlike buprenorphine, methadone may only be prescribed and dispensed in OTPs. It has not seen the same COVID-era flexibilities given the risk of overdose with methadone. Advocates in the space have called for telehealth induction for methadone for years.

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