DEA’s New Telehealth Rules are Medical Malpractice for People with Opioid Addiction

I worked on Capitol Hill and in state houses across the country for years, before a seemingly benign OxyContin prescription for pain sent me into a decade long tailspin that nearly ended my life. If I had not been able to access medication for opioid use disorder (MOUD) treatment with buprenorphine, I would not be here today. Since the beginning of my recovery in 2015, I’ve made it my purpose to increase access to treatment for every single American who needs it—without shame, judgement, or unnecessary barriers.

On February 24th, the Drug Enforcement Administration (DEA) announced new federal telemedicine guidelines that will roll back access to buprenorphine over telehealth and will contribute to more opioid overdoses and deaths. The DEA has proposed a rule that would limit telemedicine prescriptions for buprenorphine to a single 30-day supply. Under the DEA’s guidelines, any new opioid use disorder patient who starts their treatment via telemedicine must find and see an in-person provider in order to renew their prescription beyond the initial 30 days.

There is no guarantee, however, that a person will be able to access an in-person visit within one month. In 2022, the average wait time for an appointment with a new primary care provider was 26 days. Now, imagine the challenges in accessing specialty addiction treatment and medication for opioid use disorder (OUD) in an already overburdened healthcare system that is rife with mistrust of and prejudice around people with substance use disorders. Surveys show that only 13-22% of people with OUD are able to access life-saving medications like buprenorphine. In fact, there are fewer available opioid treatment services in rural U.S. counties, with more than half of counties not having a single buprenorphine-waivered clinician—though the removal of the buprenorphine waiver requirement with the 2023 Omnibus Bill may improve this.

Beyond the logistics, a limited 30-day prescription of buprenorphine without guaranteed prescription refills is tremendously risky for a person struggling with opioid addiction. A large multi-site study in 2009 showed that 87 percent of OUD patients who tapered off buprenorphine over a 28-day period returned to opioid use within three months. A 2011 study showed that 93 percent of OUD patients who completed a shortened 4-week course of buprenorphine treatment returned to active opioid misuse. A Swedish study on heroin addiction from 2003 found that one year after a 6-day taper off buprenorphine, 100 percent of these patients dropped out of treatment for OUD—and 20 percent of them had died. Indeed, the potential consequences of being unable to continue buprenorphine treatment beyond 30 days are recurrence of use, overdose, and death.

Not only does the DEA’s proposed ruling put a burden on patients to seek in-person care and increase the risk of negative health outcomes for these individuals, but it also limits access to MOUDs at a critical juncture in the overdose crisis. In 2022, drug overdose deaths surpassed 107,000. At the same time, COVID-19-related lockdowns made it challenging to seek in-person care. The pandemic-fueled decision to suspend the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 and allow MOUD treatment via telehealth produced phenomenal results including increased access, decreased overdose and ER visits, improved retention, and reduced patient stigma. These successes created a strong case for massive bipartisan support for maintaining COVID-era access to telemedicine.

If the Biden Administration is going to let the DEA—an enforcement and policing agency, not a medical agency—drive healthcare policy for opioid use disorder in the middle of an overdose crisis, they should at least insist that the DEA’s medical guidance be evidence-based. There is absolutely no evidence that a single in-person visit before or after a telehealth visit has a positive impact on increasing access to addiction treatment or MOUD, improving patient outcomes, or reducing the misuse or diversion of buprenorphine.

On the contrary, a landmark study in JAMA Psychiatry found that telehealth delivery of MOUD during the COVID-19 pandemic was associated with improved retention in care and reduced odds of overdose for Medicare beneficiaries. The authors, who are from the Centers for Disease Control and Prevention, National Institute on Drug Abuse, and Centers for Medicare and Medicaid Service, all call for strategies to increase—not hinder—access to MOUD.

The DEA’s proposed rule creates barriers for patients who desperately need care, ultimately perpetuating the stigma associated with OUD. Access to telehealth buprenorphine prescriptions has been essential for opioid use disorder patients, and there is no justification for restricting access to this life-saving treatment. How the DEA landed at a non-medical, nonsensical solution like a 30-day supply is unconscionable and it must be reversed.