Addiction Telemedicine Has Saved Lives. Let’s Keep It Going

Addiction Telemedicine Saves Lives. Let’s move on

Who Robert Kent

Addiction medicine came unlocked In the time of COVID, a small supply of silver a decrease in the number, but still terrible, between US overdose deaths. As the pandemic recedes into public memory, maintaining the benefits of these changes is important if we are to continue saving lives.

In November the Federal Drug Enforcement Administration (DEA) he extended a rule allowing the prescription of the drug buprenorphine for opioid use disorders without an initial in-person evaluation. This telemedicine authorization extension will last until the end of December 2025. Although this is a positive step, this rule and similar ones should be made permanent.

After the pandemic, and with such changes, overdose deaths in the US have fallen Less than 100,000 every year “Enacting these policies is a step in the right direction in fighting the overdose epidemic, increasing equitable access to care, reducing the stigma of seeking opioid use disorder treatment, and take technology in medicine“says Bobby Mukkamala, chair of the American Medical Association’s (AMA) Substance Use and Pain Care Task Force and a member of the AMA’s Board of Trustees, echoing many addiction experts. To do otherwise will lead to unnecessary death without legitimate cause. The Trump administration and Congress must they can play a role in further reducing overdose deaths by 2025 by taking a critical step toward immediate consideration and action.

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Buprenorphine is one of three opioid use disorder medications approved by the FDA treating opioid use disorder. Buprenorphine is a controlled substance, and any practitioner who wishes to offer it must register with the DEA. Before the “X-reporting” requirement was eliminated in December 2022, buprenorphine was also required by prescribers. An additional DEA permit.

As part of the COVID public health emergency, the federal government authorized practitioners prescribe buprenorphine without having to make a personal visit and after the initial telemedicine visit, using an audio-visual or telephone connection. The DEA held two days of public hearings in 2023 and received testimony from leading experts in the field, as well as more than 38,000 comments; it was in response to that opinion The DEA and the Department of Health and Human Services (HHS) extended the current telemedicine flexibility until the December 2025 deadline.

There is significant evidence that the impact of this rule has increased access to this life-saving medicineOvercoming the obstacles for people to start treatment, we knowing reduces overdoses.

However, there has been an ongoing effort in Washington, led by the DEA, to limit medical professionals from treating opioid use disorder with this life-saving drug. The first attempt took place in 2023 when The DEA proposed a rule this would have required that any patient started on buprenorphine through a telemedicine visit be seen in person by the prescriber within 30 days of issuing a new prescription. This proposed rule received thousands of negative comments, and ultimately the current rule was adopted.

The DEA then held forums on whether a permanent rule should include a “special registry” where prescribers would have to register with the DEA to provide buprenorphine for telemedicine use. to their patients.

Finally, the DEA introduced a proposed rule in mid-2024, which my time in the White House Office of National Drug Control Policy suggests likely required a registry or an in-person visit (this proposal was never made public). . That proposed rule was rejected as part of the internal approval process used by the Biden administration. Then the current rule was extended again.

The DEA’s tendency to restrict access to buprenorphine is also part of its institutionalized efforts to prevent controlled substance “diversion,” the illegal sale of illegal or illicit drugs. The flaw in the DEA’s approach is that the agency never provides evidence that buprenorphine is being diverted as a result of the telemedicine rule. Or any other circumstance, for that matter. In fact, studies have shown that the prevalence of buprenorphine misuse has decreased since then the new rule came into effect.

Given that buprenorphine misuse has trended downward under the new rule, providers should not be forced to overcome additional hurdles to prescribe life-saving medication to opioid-dependent patients under the new administration. Because buprenorphine is less likely to cause an overdose than other opioids turn off at higher doses.

With changes in US political leadership looming, it is imperative that facts, not drug war dogma, guide the new rule beyond 2025. Making this decision difficult, policy makers have historically created it. a growing web of legal restrictions on controlled substances, under the false premise that this will be reduced drug-related deaths. The science is clear: these efforts do not reduce deaths and, in fact, may lead to more.

If the incoming Trump administration can’t find a way to make the current rule permanent, Congress should consider taking such action. Another option would be for the new administration to extend the current rule until the end national opioid public health emergencywhich was implemented by President Donald Trump in 2017 during his first term.

Before we create a “special registry,” should the DEA tell us how much buprenorphine is diverted and how much is diverted from pain prescriptions rather than opioid use disorder treatment? The answers will tell us if we have a real problem or if we are looking for a “special registry” solution.

It’s not like the government has no authority. Buprenorphine prescribers are already subject to DEA oversight because they require agency registration to prescribe any controlled substance. They are also subject to additional state oversight as they must hold a state professional license to prescribe medication. And they have additional obligations to prevent prescription abuse through their state’s drug monitoring program.

Saving lives requires actions that demonstrate a true understanding of the problem. Otherwise, we will get 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 evidence of an increase in diversion, or an increase in drug-related deaths caused by easier access to buprenorphine. The evidence is quite the opposite. The new administration must further reduce overdose deaths by taking a critical step toward continued access to this life-saving drug.

This is an opinion and analysis article, and the views expressed by the author(s) are not necessarily their own. American scientific.