On November 15, 2024, the DEA announced its third temporary extension of telehealth flexibilities for prescribing controlled medications without an in-person visit. The extension will continue the measures implemented during the COVID-19 public health emergency through December 31, 2025.
The DEA cites several reasons for the extension, including ensuring uninterrupted access to buprenorphine for opioid use disorder and time to address public commentary and the recent concerns raised during its June 2024 consultations with Tribal Governments. It also signals potential future constraints by highlighting the need to give telehealth providers time to prepare for upcoming regulations.
Addressing the root causes of limited buprenorphine access
Buprenorphine, one of three FDA-approved medications for opioid use disorder, is among the most effective treatments in medicine, reducing mortality while patients remain in care. If traditional healthcare settings were sufficient to expand access to this medication, we would have seen meaningful increases in treatment uptake by now. The fact remains that there are not enough providers willing to treat addiction. Removing the X-waiver, while well-intentioned, failed to address the systemic barriers that continue to limit access to treatment. Recent research on the stagnation in buprenorphine access underscores ongoing challenges such as pervasive stigma and low confidence in prescribing among traditional providers.
Telehealth is a critical alternative for substance use disorder care. In 2023, 4 million people in the U.S. received addiction treatment via telehealth, and it’s working: patients using telehealth for opioid treatment are 37 times more likely to receive buprenorphine. And for individuals in remote and rural areas, telehealth care impacts recovery—with patients demonstrating high retention in treatment at 3 months. Telehealth not only leads to high retention; it also aligns with SAMHSA’s requirements for truly low-barrier, person-centered care.
Advocating for systemic change
While the latest extension provides critical short-term relief, a permanent solution is urgently needed to eliminate uncertainty around telehealth prescribing. More than seven years after the opioid crisis was declared a public health emergency under the Public Health Service Act, critical gaps in policy persist, perpetuating the stigma of the war on drugs. Limiting telehealth prescribing access by reverting to pre-pandemic restrictions sends a harmful message–that individuals with OUD do not deserve the same low-barrier access to life-saving medications afforded to those with other serious medical conditions like diabetes or heart disease.
This inequity must end. Workit Health remains steadfast in advocating for systemic change, working with advocacy groups to champion solutions like the TREATS Act. This would permanently establish telehealth flexibilities, ensuring that fully virtual treatment remains a right for OUD patients. Without such legislation, the temporary suspension of in-person requirements risks lapsing, potentially reversing progress made in treating this public health emergency.
If a permanent solution like the TREATS Act proves elusive, reframing the existing exemption in the context of the opioid public health emergency (PHE), as allowed for by the Ryan Haight Act, would be a good step forward. Since the declaration of the opioid PHE, nearly 500,000 lives have been lost to overdose. Extending telehealth access throughout the duration of the opioid PHE would help ensure life-saving medications are accessible while breaking down barriers to equitable care. In the meantime, we must continue working toward a sustainable long-term policy solution.
Maintaining telehealth treatment for addiction is not optional—lives depend on it.
