Rewinding time in addiction treatments costs even more lives

As overdose deaths continue to rise across the United States, the Drug Enforcement Administration (DEA) was allowing health care providers to prescribe life-saving treatment for opioid use disorder (OUD) via telemedicine. I suggested rolling back the pandemic-era rules. This proposal is the wrong approach and can lead to overdose death and despair in patients seeking treatment.

Today, healthcare providers with a DEA-issued controlled substance license can remotely prescribe buprenorphine (OUD’s FDA-approved drug) to patients. However, this is not always the case. Before the COVID-19 pandemic, clinicians were required to see every patient in person before prescribing drugs. And Congress, in a rare bipartisan show, agreed to scrap a onerous rule that required clinicians to undergo hours of additional training and obtain a DEA waiver before prescribing buprenorphine.

These are long-awaited changes that can change the way patients receive care and ultimately save lives. Buprenorphine has been shown to reduce overdose deaths, curb illicit drug use, slow the transmission of infectious diseases, and help people stay on treatment longer.

A recent study found that pandemic telemedicine regulations helped patients initiate and continue buprenorphine treatment, and patients abstained from illicit opioids in similar proportions as those treated directly. Clinicians who have used telemedicine at times have found that telemedicine increases access and convenience for patients, especially those in rural and remote areas, who use syringe service programs, are imprisoned, or become homeless. I am reporting that Notably, research also shows that increased access to buprenorphine does not lead to buprenorphine-related overdose.

But the DEA’s proposal retreats from these benefits, allowing patients only 30 days of supplies prescribed via telemedicine before they need to actually see a doctor. Problems with this approach The point is, the barriers that keep people from seeing their healthcare providers in person persist after 30 days. They will still struggle to find child care, miss work, travel long distances, and pay for transportation. They continue to combat the fear, stigma, and discriminatory practices that often greet people seeking addiction treatment directly. There are cases.

And what if the patient doesn’t get a new prescription after 30 days? Buprenorphine is a daily drug. Missing even one dose can cause painful withdrawal symptoms. If the DEA cuts off access to prescriptions, desperate patients may try to manage their symptoms by turning to the street supply of illegal and often deadly fentanyl-contaminated drugs.

So why is the DEA suggesting a rollback?

Agencies have long been concerned about the diversion of obtaining buprenorphine indirectly, buying it illegally to get high, or selling it to others. may occur. The DEA also seems confident that in-person visits will help providers better monitor patients, ensure they use their medications as prescribed, and reduce diversion. However, there is no evidence that this is true.

Rather, research shows that the main driver for people trying to obtain buprenorphine illegally is trying to manage their OUD symptoms without seeking legal treatment. Making buprenorphine more accessible through telemedicine would help solve a diversion problem that the DEA itself acknowledges.

Having 12 years of experience recovering from substance use disorders, I know the desire for treatment. I also know that people like me have a slim chance of getting treatment before they change their mind. is involved. More lives will be lost when OUD treatment requires in-person appointments. If we are not here, we cannot embark on the journey of recovery.

I urge the DEA to revise the proposed regulations to remove the requirement that patients be seen in person to continue buprenorphine treatment. Remote access to buprenorphine during the pandemic has changed patients’ lives. Now is not the time to prioritize fears of drug diversion over better access to this life-saving addiction care. must continue. our lives depend on it.

Dr. Brandee Izquierdo is Director of Behavioral Health Programs at The Pew Charitable Trust.