We published an article recently about medication-assisted treatment (MAT) and telehealth that reviewed the latest evidence on the safety and effectiveness of MAT delivered through video or audio communications technology.
We included the results of studies on MAT and telehealth conducted during the COVID-19 pandemic, when the Drug Enforcement Agency (DEA) relaxed rules on MAT to enable people with opioid use disorder (OUD) to access MAT services in the context of the various public health safety measures implemented to slow the spread of COVID before scientists developed an effective vaccine.
To learn the details from that study, please navigate to the blog on our website and read:
New Developments in Medication-Assisted Treatment (MAT): The Role of Telehealth
The primary takeaway from that article is that MAT via telehealth works.
Patients approve, providers approve, and expanded access means more people who need treatment can get the treatment they need when they need it. Some patients and providers prefer in-person treatment, but patients who experience significant structural barriers to care benefit most from MAT via telehealth. In some cases, lifesaving treatment with MAT would be close to impossible without some provision for using telehealth in place of in-person visits, especially with regards to initiating treatment.
The Benefits of Telehealth
Before COVID, most of us knew about telehealth and/or video visits with healthcare providers. The benefits of telehealth/video consultations are obvious. While nothing is better than an in-person visit with a real human, we all recognize that, compared to in-person visits, remote visits can be:
- More efficient
- More convenient
- Less expensive
In addition, telehealth/video consultations increase access to vital care for:
- People in rural areas
- People with mobility issues
- Patients with severe health conditions
- Immunocompromised patients
Telehealth and video care works for anything that doesn’t require a lab test or a direct physical exam. Patients can access appropriate care for common physical ailments, ask providers general non-emergency questions, refill prescriptions, and participate in therapy or counseling for mental health, substance use, and/or behavioral disorders.
This article will discuss the role of telehealth and video care in one specific area: medication-assisted treatment (MAT) with buprenorphine for people diagnosed with opioid use disorder (OUD). We want to know what kind of data the DEA and other policymakers are using to decide the long-term fate of MAT
Medication-Assisted Treatment: The Most Effective Available Treatment OUD
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as:
“The use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”
There are three medications for opioid use disorder (MOUD) approved by the Food and Drug Administration (FDA) for MAT: buprenorphine, methadone, and naltrexone. Research shows that treatment with MOUD for people with OUD can:
- Mitigate discomfort associated withdrawal symptoms
- Decrease cravings for opioids during withdrawal and recovery
- Block the action of opioids in the brain
Research also shows the overall benefits of MAT for people with OUD include:
- Reduced risk of overdose
- Reduced overall mortality
- Improved treatment retention, a.k.a. time-in-treatment
- Decreased illicit drug use
- Decreased criminal activity/involvement with criminal justice system
- Improvements in employment
- Improvements in relationships with family and peers
Those benefits explain why MAT is known as the gold-standard treatment for people with OUD. When people with OUD engage – and stay engaged – in MAT programs, virtually everything improves. The most important metric, however, is the fact that MAT reduces risk of overdose and death by overdose: this approach to treatment saves lives.
When COVID arrived, many SUD treatment providers worried that public health measures such as shelter-in-place orders and social distancing would have a negative impact on people in MAT programs, particularly those initiating treatment for OUD. Before COVID, federal regulations required the initiation of any MAT program – whether methadone, buprenorphine, or naltrexone – to occur in-person only. In addition, other rules required in-person counseling, therapy, and medication management.
Thankfully, however, federal authorities heard and understood the warnings issued by treatment providers, and eased restrictions around MAT for OUD. The new COVID policies significantly expanded access to care by changing rules around the use of telehealth.
Let’s take a look at those changes.
Changes to MAT and Telehealth During COVID-19
During the pandemic, federal authorities eased restrictions around MAT. We’ll focus on the changes directly related to telehealth, beginning with methadone.
Methadone
COVID-era regulations allowed clinicians to:
- Treat existing methadone patients via telehealth/video visits
- Renew prescriptions for existing patients via telehealth/ video visits
- Offer counseling and therapy via telehealth/video visits
- Initiate MAT with methadone via telehealth/video visits
Now let’s look at the changes related to buprenorphine.
Buprenorphine
COVID-era regulations allowed clinicians to:
- Initiate OUD treatment with buprenorphine via telehealth/video visits
- Continue to treat existing buprenorphine patients via telehealth/video visits
- Renew prescriptions for existing buprenorphine patients via telehealth/ video visits
- Offer MAT-related counseling, therapy, and support via telehealth/ video visits
In 2024, the pandemic is in the rear-view window. With vaccines readily available, tailored to each new strain of the virus, it’s now moving toward the status of yearly flu. It’s dangerous and even deadly for some people, but for most people, it’s now – more or less – another a respiratory illness that disrupts our lives for anywhere from a couple of day to a couple of weeks.
No fun, but no longer an acute public health crisis.
In light of this, federal regulators are in the process of reviewing the changes they made to MAT rules made during COVID. As we mention in the beginning of this article, the DEA officially made an important announcement in March 2024:
The COVID-era rules are now permanent for patients with OUD using MAT with methadone or buprenorphine in opioid treatment programs (OTPs).
However, they did not make the rules permanent for office-based opioid treatment programs, called OBOTs, where a large proportion of people with OUD engage in MAT with buprenorphine.
The people these rules impact directly – people with OUD, their families, and the providers show treat them – are now waiting to learn to know if federal regulators will make these rules permanent for OBOTs as well as OTPs, create a new set of rules for OBOTs, or decide to revert to the restrictions in place before the pandemic.
What Will Happen if We Don’t Make Rule Changes Permanent for OBOTs?
In our next article, we’ll review new research related to MAT with buprenorphine among a nationally representative sample of veterans engaged in MAT through the Veterans Administration. The research we’ll discuss addresses this question:
Among Veterans Health Administration patients receiving buprenorphine for opioid use disorder in the year following implementation of COVID-19–related telehealth policies, did patient characteristics and retention differ across treatment modalities?
Those are things providers who work in SUD treatment needs to know, because the data – and data from other studies like it – will likely shape how providers deliver MAT-associated care in the years to come.
We’ll do anything we can do to reduce the harm caused by the opioid epidemic. If the data indicate the benefits of using telehealth for MAT outweigh the risks, then we’ll advocate for leaving the new rules in place for OBOTs and look for ways we can increase the use of telehealth in our MAT programs for people with OUD.