HHS Expands Telemedicine Use in Opioid Abuse Treatment Programs

The new rule, announced today, enables healthcare providers to use audio-visual telemedicine platforms to evaluate new patients for methadone treatment programs

Healthcare organizations looking to get a handle on the opioid abuse epidemic can now use telemedicine to extend opioid treatment programs (OTPs) to the home.

The US Department of Health and Human Services published a final rule today in the Federal Register that, among other things, allow providers to evaluate new patients for a methadone-based treatment via audio-visual telemedicine. The rule is supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), which issued guidance in May 2023 enabling providers to use telemedicine for buprenorphine-based treatments.

The announcement marks the first time in 20 years that HHS has revised its rules to expand treatment options. Healthcare organizations have long been restricted in how they use telemedicine and digital health tools for substance abuse treatment, which often require in-person services that hinder patients who face barriers to access.

“This final rule represents a historic modernization of OTP regulations to help connect more Americans with effective treatment for opioid use disorders,” Miriam E. Delphin-Rittmon, PhD, the HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA, said in an accompanying press release. “While this rule change will help anyone needing treatment, it will be particularly impactful for those in rural areas or with low income for whom reliable transportation can be a challenge, if not impossible. In short, this update will help those most in need.”

Other aspects of the final rule that aid in treatment expansion include making permanent a pandemic-era waiver that allows providers to prescribe take-home doses of methadone; allowing nurse practitioners and physician assistants to order medications for treatment programs (where states allow); removing the requirement that a patient have a history of addiction for at least a year before entering a program; expanding access to interim treatment; and “promoting patient-centered models of care that are aligned with management approaches for other chronic conditions.”

The federal rule continues a nationwide effort to address substance abuse—and, in a larger context, behavioral health issues—through new programs that take into account both the nationwide shortage of qualified providers and barriers to access, including social determinants of health.

“At HHS, we believe there should be no wrong door for people who are seeking support and care to manage their behavioral health challenges, including when it comes to getting treatment for substance use disorder,” HHS Deputy Secretary Andrea Palm said in the press release. “The easier we make it for people to access the treatments they need, the more lives we can save. With these announcements, we are dramatically expanding access to life-saving medications and continuing our efforts to meet people where they are in their recovery journeys.”

The rule doesn’t make all the restrictions disappear. It specifies that providers can use telemedicine to evaluate a new patient for entering methadone treatment but not for prescribing methadone.

Prescribing rules are still very tricky in substance abuse treatment. The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 prohibited the online prescription of scheduled drugs, though it did call for a process by which providers could register with the US Drug Enforcement Agency to prescribe some controlled drugs via telemedicine without first needing an in-person evaluation. The DEA never set up that process, despite intense lobbying from the American Telemedicine Association and others to do so.

With the pandemic, HHS established a number of waivers aimed at expanding access to telehealth and digital health, including allowing for virtual prescriptions. Those waivers ended last year with the federal Public Health Emergency, but Congress voted to extend many of them until the end of 2024. The DEA has extended its waiver until the end of the year as well as it works to come up with new, permanent rules to prescribing by telemedicine.