Report recommends states eliminate regulations on telehealth and on methadone and buprenorphine that are more restrictive than federal guidelines.

By Brian Skinner, Esq.

A new report from researchers at the Johns Hopkins Bloomberg School of Public Health offers recommendations aimed at federal, state, and local policymakers to address the opioid epidemic during the pandemic, which has seen sharp increases in fatal and nonfatal overdoses.

The report “Saving Lives From Overdose During a Pandemic” draws from peer-reviewed research on opioid overdoses, as well as recommendations from the World Health Organization and the Centers for Disease Control and Prevention.Recommendations include detailed policy solutions in the areas of data and surveillance, harm reduction, and treatment, with special considerations for vulnerable populations.

A majority of states—more than 40—have reported increases in opioid-related deaths since the beginning of the pandemic, according to Overdose Detection Mapping Application Program (ODMAP), a mapping program that collects suspected fatal and non-fatal overdoses in real time across jurisdictions in the United States. Nationwide, there’s been an 18 percent increase in overdoses since the beginning of 2020, according to ODMAP.

The COVID-19 pandemic has resulted in nearly 18 million total cases in the U.S., and nearly 318,000 deaths, since January 2020. According to the Centers for Disease Control and Prevention, opioid-related overdoses accounted for over 47,000 deaths in 2018, the last year for which data are available. Drug-related deaths are four times greater than they were in the 1990s.

With regard to treatment, the report notes that during the pandemic, it is critical to maintain and expand access to lifesaving substance use treatments including opioid agonist medication treatment for opioid use disorder. People in treatment for opioid use disorder are likely to be at high risk for serious illness from COVID-19, as a result of other chronic illnesses including diabetes and lung disease. For many vulnerable patients, substance use treatment services may be the only point of access to care, making it even more important that these organizations act as a critical access point to educational resources, and testing and vaccination for COVID-19.

The federal government has taken several actions to enhance access to substance use treatment on an urgent basis. These include regulatory changes issued by the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) allowing for telehealth initiation of buprenorphine and flexibility with methadone dispensation, including permitting non-healthcare workers to deliver methadone to patients at home in lockboxes. However, with overdoses on the rise, it is important that states also take steps to expand access to substance use treatment, including medications like methadone and buprenorphine.  

To that end the report calls for states to eliminate requirements that limit access to or billing for telemedicine. Despite the relaxation of federal rules that now permit flexibility in telehealth treatment of opioid use disorders, state-level restrictions may still be in place. Specific recommendations include the elimination of restrictive requirements, specifically those that limit access to or billing for telemedicine, limit telehealth initiation of buprenorphine or methadone, or impose challenging constraints on medication provision, such as behavioral health counseling.

States should also promote and facilitate telehealth access. For example, when federal regulations were relaxed, Tennessee began permitting telephonic visits in lieu of office visits for weekly, biweekly, and monthly office visits with a physician, case manager, or counselor.

The report comes at a critical time. Despite the recent availability of vaccines to health care workers, the elderly and high-risk individuals, the nation is seeing record levels of positive cases, hospitalizations, and deaths. It is unlikely that the vast majority of Americans will be vaccinate before early summers 2021. Those suffering from substance use disorder will to continue to suffer access to treatment challenges. Consequently, the overlapping COVID-19 and overdose crises demand urgent public health action. These recommendations should be immediately considered by policymakers in the areas of funding, data and surveillance, harm reduction, and treatment, and for special populations to ensure equitable response to the overdose epidemic in an era of COVID-19.

Brian is the former counsel to the West Virginia House of Delegates Judiciary Committee and counsel to the West Virginia Senate Minority Caucus. He was also general counsel to the West Virginia State Health Officer and Commissioner for the Bureau for Public Health. He has almost two-decades of experience as a strategic advisor and chief legal counsel to both executive and legislative branch public officials.