Substance use disorder (SUD) treatment executives are largely optimistic that COVID-era telehealth prescribing flexibilities, set to expire in December 2024, will be made permanent.
But information released from a Drug Enforcement Administration (DEA) insider and published in Politico Pro in the days since SUD executives spoke with Addiction Treatment Business suggest an outcome different from what they originally hoped.
“We’re cautiously optimistic that DEA will develop a process through which patients are able to safely continue to receive telehealth care,” Gil Kochman, CEO of Workit Health, told ATB. “We’re also optimistic that DEA will finally fulfill its responsibility to create a special registration process that pre-approves providers like ours to safely prescribe addiction treatment medications via telehealth.”
Ann Arbor, Michigan-based Workit offers virtual therapy, medication-assisted treatment and psychiatric services for opioid use disorder (OUD) and alcohol use disorder.
If the DEA does roll back flexibilities, patients who depend on virtual appointments for prescriptions like buprenorphine may be faced with barriers, potentially jeopardizing their access to these essential medications.
Research demonstrates that intake via telehealth for buprenorphine treatment increases the chances that a patient remains in treatment. The increased convenience may be especially impactful for marginalized groups including Black people, who are less likely to stick with treatment for at least 90 days compared to white people.
Virtual appointments eliminate the need for patients to secure transportation, time away from work and child care, factors that are most likely to impact rural or low-income populations.
“It’s hard to separate my prediction from my hope. I hope the DEA does the right thing,” Dr. David de Gijsel, Better Life Partners’s chief health officer, told ATB. “We’re on the right path to increasing access to buprenorphine, and therefore it would be swimming upstream to now reinstate some telehealth requirements that require you to see somebody before you can start them on buprenorphine.”
Hanover, New Hampshire-based Better Life Partners offers mental health services, care coordination and SUD treatment to treatment providers, community organizations and public health organizations. The company raised $26.5 million in 2023.
While telehealth appointments greatly improve access to care, concerns about drug diversion remain. This issue arises when patients use a drug for reasons other than those intended or when someone other than the prescribed individual takes the drug.
Concerns like drug diversion have led some to suggest that the DEA may install “guardrails” that require some in-person appointments.
“I anticipate telehealth will continue, but there will be some requirements for periodic in-person exams, whether it’s within so many months, … [or] once or twice a year or however often,” Lee Dilworth, president and CEO of ReVIDA Recovery, told ATB.
Nashville, Tennessee-based ReVIDA operates nine OUD facilities across Tennessee and Virginia. Its services include medication-assisted treatment and individual and group therapy.
However, loosened regulations do not appear to have caused significant issues with drug diversion, according to Dr. Steven Pratt, senior medical director for the employer segment within Magellan Healthcare.
“I think it unlikely that we will return to the same restrictions that were in place before the pandemic,” Pratt said. “The proposed rules essentially make the looser rules permanent.”
Frisco, Texas-based Magellan Healthcare is a subsidiary of Magellan Health, a provider of behavioral health and other services.
If strong evidence did emerge suggesting that drug diversion was a growing problem, Pratt told ATB he would expect the DEA to tighten regulations.
Reporting by Politico Pro suggests that the DEA is likely to require prescribers to deal with more red tape when prescribing drugs.
Among the restrictions that were said to be added are limits that require no more than half a provider’s prescriptions to be written in a telehealth appointment, requirements for Schedule II drugs to be prescribed in person unless the prescriber is a specialist and conditions that prescribers check all 50 prescription drug monitoring programs.
Industry leaders expressed strong negative opinions when the DEA last opened a public comment period in 2023, which Dr. Suzette Glasner, chief scientific officer of Pelago, told ATB was evidence that the DEA is open to listening to industry insiders.
“Bottom line, I’m hoping that they’re cemented,” Glasner said. “My hope is that we can just continue along and do the same thing that we’ve been doing.”
