In May, the Centers for Disease Control and Prevention released an encouraging report showing that 2023 saw overdose deaths decrease for the first time in 5 years. This is no coincidence. In 2023, 63% of appointments for behavioral health were completed via telehealth (the highest percentage of any specialty), allowing millions of Americans to access addiction and psychiatric care for the first time. It was also the first year that providers did not need a special registration “X waiver” to prescribe buprenorphine, allowing even more patients to access this critical medication. Buprenorphine is a lifesaving medication that treats opioid use disorder, reducing overdose death risk by over 80%.
As an addiction psychiatrist, I’ve seen firsthand that timely and effective care for individuals struggling with substance use disorders (SUDs) is crucial. Quicker and easier access to care often makes the difference between life and death. Telehealth is an essential component in saving lives.
Despite this progress, telehealth for addiction treatment is currently scheduled to expire at the end of 2024. The Drug Enforcement Administration (DEA) has proposed new rules around the prescribing of controlled substances like buprenorphine via telemedicine. These proposed changes are aimed at reintroducing some restrictions that were lifted during the COVID-19 pandemic, such as requiring an in-person visit before prescribing a controlled substance like buprenorphine. While these rules seek to address concerns about misuse and diversion of controlled substances, they will also limit access to legitimate care for millions of Americans battling addiction.
The DEA’s proposed regulations are a big step back for addiction treatment at a time when this type of care is needed the most. Limiting telehealth in this way will disproportionately affect rural communities, minority communities, and lower socioeconomic communities, leaving our most vulnerable populations at the highest risk of recurrence and overdose.
For perspective, Alaska is the largest state in the country. At more than double the size of the next largest state Texas, it spans 665,384 miles. Alaska’s current population sits at 733,583. Almost nine percent of Alaskans require intense substance abuse treatment, and thirty-eight percent of Alaskan men meet the criteria for binge drinking.
Guess how many Addiction Psychiatrists reside in Alaska? Two. How can we, in good conscience, ask over sixty-six thousand Alaskan Americans to drive thousands of miles (one way) to attend an in-person appointment for a buprenorphine prescription? That is equivalent to driving from Washington, DC, to Atlanta, Georgia. Heck, I can barely motivate myself to drive three miles down the road to buy a carton of milk. Do we really expect folks to drive these distances to attend an in-person appointment? Ain’t gonna happen. People will forego treatment altogether. People will die.
If in-person appointment requirements return, many people who have an addiction will turn to the black market to try and obtain buprenorphine to detox. The DEA’s intention with in-person appointments is to reduce diversion. But ironically, these artificial barriers will result in moreuse of illicit buprenorphine, not less. Many people seeking buprenorphine to detox and remain off opioids like fentanyl who cannot get to an in-person provider (i.e., most of Alaska?) will inevitably pursue other, more dangerous, illicit means to get the medication. Having prescribed buprenorphine to hundreds of patients for the past fifteen years, I can say patients do NOT seek buprenorphine to abuse it. It’s very difficult to abuse due to its unique chemical structure. They seek buprenorphine to detox off fentanyl and stay alive.
If you are concerned about this too, there are two important steps you can take to help protect telehealth addiction treatment before time runs out in December:
1. Urge your Congressional Representatives to pass the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act
The TREATS Act would extend the use of telehealth for addiction treatment services, ensuring that individuals can continue receiving care without having to make unnecessary in-person visits. It offers a balanced approach to maintaining some safeguards while continuing to expand access to care. The TREATS Act will soon go to the floor of the Senate for a vote and then to the House of Representatives. Passing the TREATS Act would allow healthcare providers like me to continue prescribing medications for addiction without the need for an initial in-person visit. This would maintain a critical pathway for care, particularly for those in rural or underserved areas who do not have easy access to addiction specialists. Washington, DC, to Atlanta, Georgia, is a very long drive.
Writing a simple email to your respective Senators and House representatives requesting they vote for the TREATS Act will go a long way. You can even click here to send a pre-populated letter with this request to Congress.
2. Ask your U.S. House of Representatives member to co-sign Congresswoman Ann Kuster’s letter to President Biden
This week, U.S. House of Representatives member Ann Kuster from New Hampshire wrote a letter to President Biden urging him to use executive action to give permanent protection to telehealth for addiction treatment. If passed, this executive order would allow addiction psychiatrists and healthcare providers across the country to continue offering telemedicine services without interruption, even before Congress enacts a more permanent solution like the TREATS Act.
The letter represents a vital, bipartisan effort to maintain the progress we’ve made in treating addiction through telemedicine. Asking your congressman to co-sign this letter will show widespread support for protecting those at risk of falling through the cracks in the US healthcare system. The letter is scheduled to be sent to President Biden’s office this coming Monday, September 30th. You can email and ask your respective House of Representatives member to co-sign the letter. Don’t know who your rep is? Click here to find out. All House offices received a copy of the letter this week. The more signatures, the more attention the request will get.
Of note, all U.S. House of Representatives members and many Senators are running for re-election this November. So, they are especially focused on your voice right now. Take advantage of the opportunity. Use your power. After all, our representatives work for us.
The ongoing opioid public health crisis and high overdose rates underscore the need for innovative solutions that expand access to treatment to those who need it the most.
The COVID-19 pandemic forced healthcare to evolve quickly. Telehealth emerged as a vital tool for individuals seeking mental health and addiction treatment. Telehealth allows patients to access care safely from their homes, removing artificial barriers such as transportation, stigma, finances, and geographic location. For many Americans, this virtual connection is the only way to access life-saving treatments such as medication-assisted treatment (MAT) for opioid use disorder (OUD). Your ability to receive addiction treatment should not depend on what part of the country you live in or how much money you have in the bank.
Limiting treatment access with in-person requirements will cost lives. It is also not medically necessary. As an average citizen, you hold incredible power to influence the legislative decisions that affect our nation’s health. Your actions can ensure that addiction treatment via telehealth remains accessible to everyone, particularly those who are most vulnerable.
We can help those in need continue to receive the care they deserve, reduce overdose deaths, and make our communities healthier and safer. The opioid epidemic is heartbreaking. But it is not inescapable. It is not inevitable. With telemedicine and expanded access to buprenorphine, we already have the tools we need to end this epidemic for good. We can still write our own destiny in this dark chapter of American history. The ending remains unwritten. You have the pen.
About Aware Recovery Care
Aware Recovery Care helps adults 18 years of age and older affected by addiction recover at home through its groundbreaking, evidence-based in-home addiction treatment (IHAT) model. By transforming the home into a treatment center and delivering collaborative care with lived experience to those in need, Aware empowers individuals and their loved ones to thrive and make sustainable recovery possible. The program helps clients learn new skills and daily habits to achieve and maintain recovery, health, and wellness while remaining in their community, thereby avoiding the often-difficult return home seen from traditional treatment options. Aware now operates in 11 states (CT, FL, GA, IN, KY, ME, MA, NH, OH, RI, VA).
