The opioid crisis is a national tragedy. In the last 12 months, over 108,000 Americans were lost to drug overdoses, the most on record, with over three-quarters of those untimely deaths involving opioids. Shockingly, illicit drugs are now the number one killer of Americans between ages 18 and 45 — more than firearms, car accidents and COVID-19 — and a major contributing factor to a sharp decline in U.S. life expectancy.
As bad as the crisis has been, it has the potential to grow even worse as several important tools in the fight against drug addiction and abuse are set to expire in the coming months. Among these is the expansion of telemedicine to treat those suffering from opioid use disorder (OUD).
At the onset of the COVID-19 pandemic, the U.S. Department of Health and Human Services (HHS) and Drug Enforcement Administration (DEA) loosened restrictions to allow DEA-registered practitioners to issue medication-assisted treatment (MAT) to patients without first conducting an in-person evaluation. These drugs, including buprenorphine and methadone, are considered the “gold standard” in treating OUD, with far better outcomes than other treatment options.
The government initially granted this exemption to promote social distancing and ensure continuity of care during the unprecedented COVID-19 health emergency, but it had the added advantage of reducing the stigma and other barriers to obtaining in-person treatment, especially for vulnerable and hard-to-reach populations that often lack access to quality healthcare.
Although the impact of this change is difficult to quantify, it has undoubtedly saved lives. Indeed, recent studies have shown patients taking buprenorphine are over 60 percent less likely to suffer a fatal overdose than those not taking medication for OUD, and that prescribing buprenorphine via telemedicine is at least as effective, and sometimes more effective, at keeping patients in treatment.
Sadly, the telemedicine exemption will lapse at the end of the COVID-19 public health emergency declaration, currently set to expire on October 2022, at which point new and existing patients will lose access to these potentially life-saving services. Although the Biden administration is likely to extend the public health emergency at least until January, that still only leaves precious few months for the notoriously slow wheels of bureaucracy to turn.
The clock is ticking, and while the DEA has signaled its intention to make these regulations permanent, it is unclear whether they will be able to meet the looming deadline. And while some members of Congress have urged the DEA to fulfill this pledge “as soon as possible,” they too must be prepared to act with new legislation.
Telemedicine is not without risks, and some practitioners have expressed valid concerns that remote healthcare may lead to increased misuse or diversion of MAT from its intended purpose. However, with the U.S. drug crisis reaching truly epic proportions, the benefits of greater access to treatment significantly outweigh any potential harm. A recent study of over 500 opioid-involved deaths found only one was solely attributable to buprenorphine. Another found that increased use of telemedicine during the pandemic did not lead to an increase in misuse or overdose of methadone.
And while some claim prescribing medication-assisted treatment merely “substitutes one opioid for another,” the truth is that medically-prescribed buprenorphine is far less dangerous than illicitly manufactured drugs like fentanyl, a potent synthetic opioid more than 50 times stronger than heroin. Certainly, both have the potential for misuse, but if prescription MAT is a single lit match, illicit fentanyl is a raging four-alarm fire.
The use of MAT is much preferable to illicit drugs found online or on the street, and telemedicine is an important step to improving access to treatment and helping to unwind the Gordian knot of the U.S. opioid crisis. The goal of drug treatment programs should be to eliminate drug use, but for many suffering from OUD, recovery is an iterative process, and quitting may not be possible, at least not right away. In the meantime, drugs like buprenorphine and methadone can help curb withdrawal symptoms and cravings while dramatically reducing the likelihood of overdoses.
As the COVID-19 public health emergency draws to a close, it is imperative policymakers move quickly to make these effective, commonsense changes permanent so healthcare professionals can continue to reach those most in need. The risk of inaction is simply too great.
Jim Crotty is an associate vice president at The Cohen Group, a strategic advisory firm in Washington, D.C. He is the former deputy chief of staff at the U.S. Drug Enforcement Administration. The views expressed are the author’s own.