Addiction telemedicine saved lives. Let’s continue

Addiction telemedicine saved lives. Let’s continue

Written by Robert Kent

The addiction drug, unleashed in the age of coronavirus, offers a small glimmer of hope at a time when the number of overdose deaths in the U.S. is declining but still alarming. It has become. As the pandemic fades from public memory, preserving the benefits of these changes is critical if we want to continue saving lives.

In November, the federal Drug Enforcement Administration (DEA) extended a rule that allows prescriptions for the drug buprenorphine for opioid use disorder without an initial in-person evaluation. This telemedicine permit extension is until the end of December 2025. While this is a positive step, this and similar regulations need to become permanent.

In the aftermath of the pandemic and such changes, the number of overdose deaths in the United States has fallen to less than 100,000 per year. “Strengthening these policies is the right move in the fight against the worsening overdose epidemic by increasing equitable access to care, reducing the stigma of seeking treatment for opioid use disorder, and embracing technology in health care.” It’s a step in the right direction,” said the council’s chairman, Bobby Mukamala. He is a member of the American Medical Association (AMA) Substance Use and Pain Care Task Force and the AMA Board of Directors, and shares the views of many addiction experts. Failure to do so will lead to unnecessary deaths for no good reason. The Trump Administration and Congress can play a critical role in further reducing overdose deaths in 2025 by taking important steps to consider this issue and take action soon.

About supporting science journalism

If you enjoyed this article, please consider supporting our award-winning journalism. Currently subscribing. By subscribing, you help ensure future generations of influential stories about the discoveries and ideas that shape the world today.

Buprenorphine is one of three opioid use disorder drugs approved by the FDA to treat opioid use disorder. Buprenorphine is a controlled substance and physicians who wish to provide buprenorphine must register with the DEA. Prior to the removal of the “X Waiver” requirement in December 2022, additional DEA approval was also required for buprenorphine prescribers.

As part of the coronavirus public health emergency, the federal government will allow medical practitioners to prescribe buprenorphine after an initial telehealth visit using an audiovisual or telephone connection, without requiring an in-person visit. did. The DEA held a two-day public hearing in 2023 that received testimony from leading experts in the field and received more than 38,000 comments. In light of this feedback, the DEA and the Department of Health and Human Services (HHS) have extended the current telehealth flexibility through December 2025, the current limit.

There is significant evidence that the impact of this rule has increased access to this life-saving drug, overcome barriers to people starting treatment, and reduced overdoses.

Nevertheless, there are ongoing efforts in Washington, led by the DEA, to restrict medical professionals from treating opioid use disorder with this life-saving drug. The first effort came in 2023, when the DEA proposed a rule that would require patients started on buprenorphine via telemedicine to be seen in person by a prescriber within 30 days before a new prescription can be issued. did. The proposed rule received thousands of negative comments, and the current rule was ultimately adopted.

The DEA then held a forum to solicit input on whether the permanent rule should include “special registration.” The registration requires prescribers to register with the DEA to provide buprenorphine to patients using telemedicine.

Finally, the DEA submitted a proposed rule in mid-2024, which in my experience when I was in the White House Office of National Drug Control Policy is likely to include the need for registries and in-person visits. (This proposal was never made public.) The proposed rule was rejected during an internal approval process adopted by the Biden administration. The current rules have since been further expanded.

The DEA’s tendency to restrict access to buprenorphine is also part of an institutionalized effort to prevent controlled substance “diversion,” or the illegal sale of legal or illegal drugs. The flaws in the DEA’s approach center on the fact that the DEA has not provided any evidence that buprenorphine is being diverted for purposes of telemedicine regulations. Or any other situation. In fact, studies show that the prevalence of buprenorphine misuse has decreased since the new rules went into effect.

Given the evidence that the new rules are reducing buprenorphine misuse, health care providers should not be forced to overcome additional barriers to prescribing life-saving drugs to opioid-dependent patients under the new administration. Buprenorphine is less likely to cause an overdose than other opioids because its effects diminish as the dose increases.

As changes come to America’s political leadership, it is imperative that the new rules for 2025 and beyond are guided by facts rather than drug war dogma. Complicating this decision is that policymakers have historically expanded the web of legal restrictions on controlled substances under false assumptions such as: This reduces drug-related deaths. The science is clear. These efforts will not reduce deaths; they may actually increase them.

If the incoming Trump administration cannot find a way to make the current rules permanent, Congress should consider such a measure. Another possibility is that the new administration extends the current rules until the end of the national opioid public health emergency introduced by President Donald Trump during his first term in 2017. Dew.

Before creating the “special registry,” the Drug Enforcement Administration must determine how much buprenorphine is being diverted and how much is being diverted to pain prescriptions rather than treating opioid use disorder. Shouldn’t it? The answer will tell you if there is actually a problem or if a “special registry” is the solution to fixing the problem.

It’s not that the government doesn’t have power. Buprenorphine prescribers are already subject to DEA oversight because they must register with the agency to prescribe the controlled substance. Additionally, you must hold a state professional license to prescribe medications, which means you are subject to additional state supervision. There is also an additional obligation to prevent prescription abuse through state prescription drug monitoring programs.

Saving lives requires action based on a true understanding of the problem. Failure to do so will only lead to more overdoses and more deaths.

We have nearly three years of evidence showing the benefits of prescribing buprenorphine without the need for an in-person visit. There is no indication that easy access to buprenorphine causes increased conversions or drug-related deaths. The evidence is just to the contrary. The new administration must further reduce overdose deaths by taking important steps to continue access to this lifesaving medicine.

This is an opinion and analysis article and the views expressed by the author are not necessarily those of the author. scientific american.