Addiction treatment got easier during Covid. A new proposal would keep it that way

Addiction treatment got easier during the Covid-19 pandemic — and the Biden administration wants to keep it that way.

Federal regulators on Tuesday announced a proposal to take the emergency policies enacted in 2020, in response to the emerging pandemic, and make them permanent. In particular, the changes would preserve patients’ expanded access to two key medications used to treat opioid addiction: methadone and buprenorphine.

“These proposed updates would address longstanding barriers [to] treatment in regulations — most of which have not been revised in more than 20 years,” Miriam Delphin-Rittmon, the director of the Substance Abuse and Mental Health Services Administration, said in a statement.

The changes, which appear to have broad support across medical organizations and addiction advocacy groups, underscore how sharply the addiction treatment landscape has shifted in light of Covid.

They also reflect a growing recognition from Washington that many Americans experiencing opioid addiction lack access to addiction medications. While methadone and buprenorphine are both controlled substances, the emergency measures significantly increased their availability. For the first time, doctors could initiate treatment with buprenorphine via telehealth instead of an in-person visit.

Changes to methadone regulations were arguably more significant: The emergency measures allowed many patients to take home weeks’ worth of doses, instead of requiring them to show up daily to receive a single dose at a specialized facility.

“The reality is, if it is easier to get illicit drugs in America than it is to get treatment, we will never bend the curve on overdoses,” Rahul Gupta, the director of the White House Office of National Drug Control Policy, said in a statement. “When fewer than 1 out of 10 Americans with addiction can access the treatment they need, we must do more to close that addiction treatment gap, including making Covid-19 era flexibilities permanent.”

Other changes include the elimination of a requirement that doctors with a special license to prescribe buprenorphine submit a report to SAMHSA each year.

Separately, the proposal would also eliminate a requirement that patients must be addicted to opioids for a full year before beginning treatment at a methadone clinic, also known as an opioid treatment program, or OTP.

While the federal government can finalize the new regulations without input from Congress, they must undergo a public comment period before SAMHSA can formally codify them, likely at some point in 2023.

While some lawmakers and addiction medicine groups applauded the proposed changes, several argued they didn’t go far enough.

“In the spirit of these proposed rules, now is the time for Congress to build on these regulatory efforts by creating a new statutory pathway that would allow addiction specialist physicians to prescribe methadone for [opioid use disorder] treatment that can be picked up from pharmacies,” said Brian Hurley, the president-elect of the American Society of Addiction Medicine.

Sen. Ed Markey (D-Mass.), the author of a bill that would dramatically deregulate methadone by allowing any physician who specializes in addiction to prescribe the drug directly, also applauded SAMHSA’s proposal, but said Congress should take further action.

“This proposed change in federal rules would save countless lives by heeding the advice of medical providers and breaking down needless barriers to treatment,” he said. “But Congress must do more. For many, the passage of the Opioid Treatment Access Act is the difference between life and death.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.

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