Earlier this year, the U.S. Department of Health & Human Services (HHS) published a final rule permanently allowing opioid treatment programs (OTPs) to use telehealth, including phone-only, in initiating buprenorphine, a flexibility introduced during the COVID-19 pandemic. Buprenorphine is one of three FDA-approved medications for opioid use disorder (MOUD) treatment and studies show it is effective at stopping withdrawal symptoms and reducing overdose risks. Studies also show that buprenorphine treatment via telehealth has the same or better retention outcomes compared to in-person treatment. Prior to the pandemic flexibilities and this final rule, in-person evaluations were required by federal regulations for new patients to initiate buprenorphine in OTPs.
EVIDENCE ROUNDUP
This blog post is part of a Playbook series connecting evidence and implementation resources with emerging state and federal policies to help enhance services for people with complex needs.
The final rule also permanently allows certain flexibilities for methadone treatment, a form of MOUD that can only be dispensed in OTPs, though the rule stops short of allowing telehealth for methadone induction. For example, the rule allows new patients seeking methadone treatment to be evaluated via video-based telehealth, includes physician assistants in its definition of providers who can order the dispensing of methadone, and allows for discretion of OTP providers to provide patients with “take-home” doses of methadone.
Why is this important?
In the face of an overwhelming overdose crisis, largely driven by the rise in the synthetic opioid fentanyl, telehealth for MOUD treatment promises to benefit many people. Currently, prescription volumes for MOUD are low and certain under-resourced communities experience significant disparities in accessing this treatment. For example, people residing in rural communities have high rates of substance use disorder, but simultaneously face long-standing health care provider workforce shortages. Additionally, Black individuals in the U.S. have an increased overdose mortality rate compared to white individuals, yet are less likely to be offered buprenorphine compared to methadone, which is more strictly monitored and typically requires daily on-site dosing.
OTPs have decades of experience as specialty MOUD providers, serving roughly 650,000 people in more than 2,000 OTPs across the country. This final rule improves access to care by permitting health care professionals within OTPs to conduct patient evaluations and initiate buprenorphine via phone-only or video-based telehealth. Other types of health care providers, such as hospitals and primary care providers, who care for people with opioid use disorder (OUD) can consider partnering more closely with OTPs given these now permanent telehealth flexibilities for buprenorphine treatment.
HHS oversees OTPs, which are required to comply with the final rule by October 2, 2024. However, questions remain on the future of telehealth and OUD flexibilities for non-OTP providers, like outpatient addiction providers and primary care providers, where the Drug Enforcement Administration (DEA) has authority. Final rules impacting these providers are expected from the DEA in fall 2024.
What is the evidence behind the use of telehealth treatment for MOUD?
Health care providers, policymakers, and health plans can look to the following Playbook resources to better understand evidence on the use of telehealth in treating people with OUD using MOUD. Emerging evidence indicates strong levels of patient satisfaction, retention rates similar to that of in-person treatment, and high rates of adherence to buprenorphine.
- Retention in Telehealth Treatment for Opioid Use Disorder Among Rural Populations: A Retrospective Cohort Study – This peer-reviewed study assessed a rural OUD telehealth program across 14 states and showed retention rates comparable to traditional in-person treatment and high rates of buprenorphine adherence.
- Pandemic Telehealth Flexibilities for Buprenorphine Treatment: A Synthesis of Evidence and Policy Implications for Expanding Opioid Use Disorder Care in the United States – This narrative review of 41 peer-reviewed studies found strong uptake of telehealth for buprenorphine treatment during the COVID-19 pandemic, demonstrating the model’s feasibility, and was also associated with better retention in care.
- Estimated Effectiveness and Cost-Effectiveness of Opioid Use Disorder Treatment Under Proposed U.S. Regulatory Relaxations: A Model-Based Analysis – This study finds that telehealth for buprenorphine treatment in OTPs and take-home doses of methadone are cost-effective and support high treatment retention.
- Overhaul of Opioid Treatment Program (OTP) Regulations with CSAT Director Dr. Yngvild Olsen – This podcast episode details this final rule for OTPs, including reflections on how lessons from COVID-19 telehealth flexibilities have informed the final rule.
- 42 CFR Part 8 Final Rule – This online resource, designed for OTP providers by the Substance Abuse and Mental Health Services Administration, summarizes the changes in the final rule, including an FAQ document and explainer on what the changes will mean for patients.
Beyond the above resources, the Playbook’s Addiction Care Collection offers additional evidence on the use of MOUD to support adults with OUD, including through telehealth, and tools to support effective implementation.
Share Your Telehealth in OUD Treatment Resources and Tools
Do you have a resource or emerging best practice related to treating OUD via telehealth? Share your experience with the Playbook. We are interested in growing our library of evidence and implementation best practices to help those in the field strengthen and build successful programs in communities across the nation.