Senators Want Telehealth Flexibilities for OUD Drug Permanently Extended

May 08, 2023 - Led by Sen. Edward J. Markey (D-Mass.), a group of US senators have urged the Drug Enforcement Agency (DEA) to permanently establish telehealth flexibilities in prescribing buprenorphine for opioid use disorder (OUD) patients after the conclusion of the COVID-19 public health emergency (PHE) on May 11.

OUD affected 2.7 million people aged 12 and older in 2020, according to the Centers for Disease Control and Prevention (CDC).

Following the start of the COVID-19 pandemic in March 2020, many restrictions surrounding telehealth use were temporarily revoked due to barriers to in-person care that began at the time. The Substance Abuse and Mental Health Services Administration (SAMHSA) issued allowances for Opioid Treatment Programs and certified care providers to prescribe drugs and treat patients via phone without an initial in-person visit. Soon after, the DEA announced that providers could prescribe buprenorphine to new and existing OUD patients on the basis of a telehealth examination alone.

Through more accessible telehealth services, patients have gained additional opportunities to obtain treatment, reducing overdose risks.

However, the COVID-19 PHE is set to expire on May 11, meaning that telehealth prescribing flexibilities for buprenorphine will no longer be in place. This led Sen. Markey, chair of the Senate Health, Education, Labor and Pensions (HELP) Subcommittee on Primary Health and Retirement Security, to compose a letter pursuing permanently extended telehealth prescribing flexibilities for buprenorphine.

Markey wrote this letter with his colleagues Sens. Ron Wyden (D-Ore.), Martin Heinrich (D-N.M.), Jeff Merkley (D-Ore.), Sheldon Whitehouse (D-R.I.), and Elizabeth Warren (D-Mass.).

Addressed to US Attorney General Merrick Garland and DEA Administrator Anne Milgram, the letter encouraged the Biden administration to establish a permanent regulation allowing buprenorphine prescribing through telehealth.

"Given the opioid epidemic’s scope, we must ensure that all OUD medication treatment options are accessible to everyone, regardless of their geographic location, economic status, or ability. Although the DEA’s proposed rules take a step forward in incorporating telehealth, they scale back flexibilities that people relied on to access OUD medication treatment,” noted the letter. “With more than 200 U.S. overdoses each day, we must not reinstitute barriers to treatment. Now is the time to do everything in our power to give people access to the medications they need to live healthy and productive lives.”

The DEA recently announced plans to temporarily extend telehealth prescribing allowances.

This was a reversal from February when the DEA proposed limits on prescribing controlled substances through telehealth. Under the restrictions, providers would only be allowed to prescribe a 30-day supply of buprenorphine for treating OUD without a prior in-person examination.

Groups such as the ATA Action, the American Hospital Association (AHA), and the Alliance for Connected Care voiced their concerns. Through their letters, the organizations noted that the new rules could ultimately harm patients through limited access and that flexibilities enacted during the COVID-19 pandemic provided various benefits.

"We appreciate DEA's responsibility to write rules that provide effective controls against diversion and protect public health and safety but believe that the requirement that a patient see a clinician in-person is not an effective control against diversion and, instead, simply limits access to legitimate health care," said Kyle Zebley, executive director of ATA Action, the advocacy arm of the American Telemedicine Association, in its letter to the DEA.