The DEA needs to officially allow telehealth prescribing for opioid use disorder

The statistics are dismal, though they bear repeating: 81% of overdose deaths in the U.S. in 2021 involved an opioid.

But as an addiction medicine specialist, there are figures that give me hope: one seminal study showed that 75% of patients who were given the FDA-approved medication buprenorphine to treat opioid use disorder daily for 12 months remained in recovery — compared with 0% who did not receive buprenorphine treatment for the entire 12 months. That’s right: 0%.

Though there are many barriers to accessing medication for opioid use disorder, many were reduced during the COVID-19 pandemic as a result of broadened telehealth services. I’ve seen this firsthand: I work for Bicycle Health, which offers medical assistance for opioid use disorder via telehealth. But don’t just take my word for it — research shows that online treatment options have achieved undeniable benefits.

Now, this progress is under threat. The DEA is considering a rollback on these services, suggesting that people with opioid use disorder seeking treatment for the first time should receive just a 30-day supply of buprenorphine via telehealth. After this, according to the proposed ruling, patients must receive subsequent medication from an in-person prescriber. But this is where things get risky: The average time to get a doctor’s appointment in 2022 was 26 days, and even when an appointment is secured, 1 in 4 patients no-show to their in-person appointments for myriad reasons.

Much to my relief, the rollback is now under reconsideration due to the number of responses it received during the ruling’s comment period. The final decision is currently delayed until November.

But I worry that people may become complacent and consider this a permanent victory, only to be caught off-guard when the DEA makes a final decision. Now is the time for advocates to demand the DEA enshrine telehealth care. Reverting back to primarily in-person care for opioid use disorder will only lead to more dismal statistics, eclipsing those promising recovery numbers bolstered by telehealth treatment.

Missing a routine doctor’s appointment is common. People double-book themselves or simply forget. Doctors cancel appointments as well. Whatever the cause, the repercussions are generally minimal — you just have to reschedule to another time. But if in-person visits are required, someone with opioid use disorder who misses an in-person appointment, even through no fault of their own, could find their addiction recovery in jeopardy.

Required in-person care to access buprenorphine would create a dangerous ripple effect for patients who rely on the drug to maintain recovery. Not only are they forced to contend with the fact that in-person appointments take longer to secure than they have in years (8% longer than in 2017), they are left to find child care or figure out transportation to even get to the appointment. These barriers could easily push a large number of people out of recovery.

If opioid use disorder patients are unable to continue buprenorphine, they won’t just be at risk of relapsing. Withdrawal from buprenorphine can be intense, and they could find themselves in the emergency room, saddled with the bills those visits require. Still, a high emergency room bill is the best-case scenario, as suddenly stopping buprenorphine could also lead to relapse or even death.

Beyond the difficult logistics and physical limitations that will result from more required in-person care, the requirement for in-person care reinforces societal stigmas toward people with opioid use disorder. People will risk being seen waiting for in-person care and could be deterred from receiving care for fear of judgment.

Stigma against people with opioid use disorder is pervasive, especially among those tasked with helping treat it. A 2019 survey found that not even a third of PCPs were willing to have a person taking medication for OUD as a neighbor or marry into their family. And these aren’t new ideas; a 2014 national public opinion data found that negative attitudes toward those with opioid use disorder exceed those reported for other medical conditions, including mental illness.

Telehealth services have significantly supported people with opioid use disorder who wish to recover on their terms. For one, they no longer need to call out of work (and risk their jobs due to stigma) to receive routine care. Instead, they can continue with their day — and their care. And recovering in the comfort of their own space gives many people the incentive they need to receive care in the first place.

In 2022, Wilson Compton, the deputy director of the National Institutes of Health’s National Institute on Drug Abuse, stated, “The expansion of telehealth services for people with substance use disorders during the pandemic has helped to address barriers to accessing medical care for addiction throughout the country that have long existed. Telehealth is a valuable service and, when coupled with medications for opioid use disorder, can be lifesaving.”

The lifesaving measures of telehealth services and buprenorphine treatment are being threatened. If the DEA ends up rolling back telehealth services later this year, that progress will come to a crashing halt.

Danny Nieves-Kim, M.D., MPH, is an addiction medicine specialist at Bicycle Health.