Senate bill would permanently expand Covid-era rules on telehealth addiction treatment

A A bipartisan group of senators introduced a bill this week that would allow health care providers to prescribe buprenorphine, a drug commonly used to treat opioid addiction, via telehealth.

The measure, known as the Telehealth Response for E-prescribe Addiction Therapy Services Act TREATS, would permanently extend a temporary Covid-era policy that allowed patients to receive buprenorphine remotely, without an in-person visit.

While some law enforcement officials have expressed concern about the risk of misuse of remotely prescribed buprenorphine, drug treatment experts say there is little evidence to support this. In the midst of a public health crisis, they argue, any restrictions on life-saving medications like buprenorphine would harm far more than they would help.

In the depths of the Covid-19 pandemic, telehealth sessions were a lifeline for those traveling the long road to recovery while dealing with stress and isolation, said Senator Sheldon Whitehouse ( DR.I.) in a press release. Our bipartisan legislation would make telehealth flexibilities permanent to ensure that life-saving recovery support continues to be widely available from the comfort of home.

Other sponsors of the bill include Senators Lisa Murkowski (R-Alaska), Marsha Blackburn (R-Tenn.) and Mark Warner (D-Va.).

Lawmakers first introduced the TREATS Act in 2021, although it gained little traction. Its reintroduction Wednesday, however, comes amid continued debate over a controversial Drug Enforcement Administration proposal that would require patients to see a prescriber in person within 30 days of receiving a remote prescription.

The proposal sparked intense pushback from addiction treatment advocates and Democratic lawmakers, as well as provider groups like the American Society of Addiction Medicine. Many digital health companies, like Bicycle Health and Boulder Care, have taken advantage of these flexibilities to significantly expand their buprenorphine prescribing reach and volume.

The DEA has repeatedly extended its deadline to make a final decision. Currently, Covid-era telehealth flexibilities are set to expire at the end of 2024.

Buprenorphine is one of two drugs approved by the Food and Drug Administration to treat withdrawal symptoms and cravings that occur when people try to stop using opioids. Buprenorphine and another common medication, methadone, are considered the gold standard for treating opioid use disorder.

However, both drugs are opioids themselves, raising concerns that unrestricted access could lead to unintended consequences, such as misuse or even overdose. Covid-era studies, however, show that the share of opioid overdoses involving buprenorphine did not increase significantly after the new telehealth flexibilities were implemented.

Research shows that during the COVID-19 pandemic, telehealth access to buprenorphine treatment has been transformative, said Brandee Izquierdo, director of behavioral health programs at the nonprofit Pew Charitable Trusts, in a statement. More patients started and continued treatment in the last three years than in previous years, without increasing the number of overdose deaths. These patients did not have to wait long to get an appointment; they didn’t need to take time off work, find transportation, or pay for child care. And they didn’t have to deal with the judgment or stigma that too often comes with in-person office visits.

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