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Two Democratic members of the US House of Representatives have penned a letter to the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Agency, imploring the agencies to extend flexibilities for audio-based telehealth so physicians may continue prescribing medication-assisted Treatments to address opioid use disorder.
Representatives Ann McLane Kuster and Lori Trahan, of New Hampshire and Massachusetts respectively, said they’re advocates for the development of a long-term policy regarding telehealth flexibilities, particularly when it comes to administering buprenorphine to patients, a medication that helps to prevent overdose death.
They cited research from the National Library of Medicine suggesting that the COVID-19 pandemic introduced increased barriers to accessing treatment for those with opioid use disorder. Drug overdoses are increasing and disparities have been worsening over the last several years, with opioid-related overdose deaths reaching an all-time high in 2021.
Kuster and Trahan noted that the Physician Fee Schedule proposed rule regarding coverage of audio-only telehealth for buprenorphine initiation depends on if “buprenorphine is authorized by the DEA and SAMHSA at the time the service is furnished.” Since payment for services is dependent on DEA and SAMHSA guidance, the House members encouraged the agencies to release the public guidance quickly, and to include policies, such as telehealth, that increase access to OUD treatment.
WHAT’S THE IMPACT
Audio-only telehealth is an important tool for clinicians in responding to the addiction crisis, the lawmakers said. A 2021 study from the National Library of Medicine backs this up, finding that audio-only telehealth, as a “low-threshold” approach to medication-assisted treatment, was associated with better retention in care.
Previous studies also show that providers treating patients with OUD think that telemedicine, including audio-only options, should be offered in some form beyond the COVID-19 pandemic, regulations permitting.
The American Society for Addiction Medicine recently released their policy statement on telehealth, saying it’s a viable tool to increase access to buprenorphine as part of OUD treatment, “and that there is ample opportunity moving forward to study the role that audio-only care can play in responding to the opioid crisis,” the lawmakers wrote.
Calling the future of audio-only telehealth coverage “unpredictable,” the representatives requested that SAMHSA and the DEA grant telehealth flexibilities along with the declaration of a public health emergency for the opioid crisis; evaluate long-term policy for flexibilities based on the utilization and effectiveness of audio-only telehealth in relation to medication-assisted treatment; and detail a projected timeline regarding rulemaking for audio-only telecommunications for the initiation of buprenorphine for treatment of OUD.
THE LARGER TREND
Overdose deaths were rising prior to the COVID-19 pandemic, but in 2020, there was a significant increase in overdose deaths. According to provisional CDC data, overdose deaths increased more than 30% in 2020, leading to more than 93,000 deaths. This increase was driven by the use of synthetic opioids, such as fentanyl, and stimulants, such as methamphetamine and cocaine, or combinations of substances.
Pandemic restrictions intended to prevent the spread of COVID-19 have unfortunately also made it harder for individuals with substance use disorders (SUDs) to receive treatment and support services.
Providing funding for harm reduction services is one pillar of a four-pillar approach being implemented at the federal level. Evidence-based harm reduction strategies minimize the negative consequences of drug use, according to the Department of Health and Human Services.
The other three pillars of the administration’s opioid mitigation strategy are primary prevention, focusing on the root causes and predictors of SUDs, evidence-based treatment and recovery support.
A December 2021 report from the Office of Inspector General found that while more than 1 million Medicare beneficiaries had a diagnosis of OUD in 2020, less than 16% of those beneficiaries received medication to treat their condition. They accounted for fewer than 1 in 6 of all Medicare beneficiaries with OUD.
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