The COVID-19 pandemic has transformed the world seemingly overnight, with most people adhering to physical distancing and self-quarantining measures to protect themselves and others from the coronavirus. But the resulting social isolation can be devastating for people with opioid use disorder (OUD), who often require regular face-to-face interactions with health care providers to manage their chronic condition and who are more susceptible to relapse during times of high stress. In the face of this public health emergency, Congress and the Trump administration can take immediate action to ensure that people with OUD do not put themselves at further risk and continue to receive access to lifesaving care.
First, Congress should pass the Mainstreaming Addiction Treatment Act, which would remove the federal rule requiring all health care providers to undergo training before receiving a waiver from the Drug Enforcement Administration (DEA) to prescribe buprenorphine, one of three Food and Drug Administration-approved medications for OUD, to patients—a hurdle not required for any other prescription drug. In 2018, when only about 26% of people with OUD received any kind of treatment, nearly 20 million Americans lived in counties where no clinician had obtained the required waiver to prescribe the drug.
This lack of access to treatment is partly a result of the training required of providers to obtain the waiver, as well as the additional DEA scrutiny—specifically, random inspections of office records—that comes with obtaining the waiver. These hurdles don’t exist everywhere: In France, where clinicians received permission in the mid-1990s to prescribe the drug without additional education or licensing, more than two-thirds of people with OUD received medication, and overdose deaths declined by 79%, in just four years after the practice began. Here at home, members of both the House of Representatives and the Senate have introduced bipartisan versions of the Mainstreaming Addiction Treatment Act that would immediately remove training and licensing barriers and help ensure greater access to effective OUD treatment for people across the country.
Second, federal agencies should permanently relax regulations that require people with OUD to visit treatment providers in person before receiving medication. Temporary changes have been put in place: When the coronavirus began to spread, the Substance Abuse and Mental Health Services Administration (SAMHSA) began allowing patients who usually take daily trips to opioid treatment programs in order to receive methadone—another OUD medication—to take their course of treatment at home for two weeks or longer instead so as to limit face-to-face interaction and potential exposure.
Similarly, the DEA suspended a federal rule requiring patients to meet with a health care provider in person before beginning treatment with buprenorphine; patients are now allowed to have these visits by telephone or video conference. The DEA is also permitting patients to use telehealth for counseling, while the Centers for Medicare & Medicaid Services is expanding reimbursement for these kinds of services.
These temporary changes to long-standing SAMHSA and DEA regulations should be made permanent. Even before the coronavirus, the requirement for in-person visits often created challenges for people with OUD, who may have had difficulty finding transportation or needed to prioritize work or family obligations over an in-person visit. If the relaxed rules remain in place, patients will be able to more easily get the care they need even after the global threat subsides.
Finally, the DEA should expedite the approval of regulations on mobile methadone vans, which can reach patients who are unable to travel to opioid treatment programs. Methadone programs in six states and Puerto Rico use these vans to reach patients, and they can be especially helpful in rural areas where people with OUD might not have treatment options close to home. But the DEA has not approved any new mobile methadone vans since 2007, although the agency did issue draft regulations in February 2020 and accept public comments on the regulations through late April. Now, the DEA must finalize the regulations quickly so that people with OUD—no matter where they live—can more easily get the treatment they need without having to go far from home or take undue risks.
The COVID-19 pandemic has created unprecedented anxiety and uncertainty for people around the world—feelings that have been linked to increased opioid cravings during past public emergencies. And, according to SAMHSA, health care providers should anticipate an increase in demand for treatment during disasters and other times of high stress—such as a pandemic with tens of thousands of Americans dead and millions of others sheltering in place. Congress and the administration must act swiftly to ensure that Americans can receive lifesaving care for OUD without the risk of possibly exposing themselves or others to COVID-19.
Beth Connolly directs The Pew Charitable Trusts’ substance use prevention and treatment initiative.
A version of this article appeared in The Hill on May 19, 2020.
This article was previously published on pewtrusts.org and appears in this issue of Trust Magazine.