New Proposed Rules Create Barriers to Buprenorphine

On Jan. 30, 2023, the Biden Administration announced it would end the COVID public health emergency, which could mean new issues regarding telehealth and Medication-Assisted Treatment when the order ends in May this year. MAT, especially buprenorphine, was expanded to online access for most people with opioid use disorder, giving greater access to desperately needed treatment for people in rural areas. Now, it appears that access to buprenorphine may be trickier than it seemed before.

The expansion has saved lives, and there have been repeated assurances by HHS, DEA, SAMHSA, and even the Biden Administration that telehealth buprenorphine patients won’t lose access to treatment. The truth, however, is murkier than it seems. It appears the DEA wants to put much stronger limits to telehealth treatment in place, which could cause unsurmountable access barriers for people who can’t go in person to get their meds prescribed.

What Will the Proposed Rules Do for MAT?

The new proposed rules, treatment advocates say, could cause more harm than good. While they say they’re not stripping access to treatment, the rules would make treatment much more difficult for vulnerable demographics. Patients will be required to have in-person exams and will not be able to continue to a fully virtual telemedicine care regimen. Patients already taking MAT will not be exempted; if their care began at a virtual clinic, they now would need to meet a treatment provider in-person to continue their care.

There seems to be little scientific reasoning behind this; unlike other treatment drugs, buprenorphine is a partial opioid agonist. It is less likely to be abused compared to other opioids due to its unique pharmacological properties and the way it is prescribed. Buprenorphine has a "ceiling effect," which means that after a specific dose, taking more medication does not produce any additional effects, making it less likely to be abused.

Increasing MAT Access Can Only Be a Good Thing

Many medical and professional societies have advocated for increased access to MAT, including buprenorphine. The American Society of Addiction Medicine (ASAM), a professional society representing physicians, clinicians, and other healthcare professionals specializing in addiction medicine, has long argued for increased access to MAT to improve treatment for opioid addiction. The American Medical Association (AMA), the largest professional association of physicians in the United States, has supported efforts to expand access to buprenorphine as part of a comprehensive approach to addressing the opioid epidemic.

Other doctor organizations have recognized the importance of increasing access to buprenorphine to help combat the opioid epidemic and improve the treatment of opioid addiction. The American Academy of Family Physicians, American College of Physicians, and American Osteopathic Association have written letters or papers supporting increasing access to buprenorphine.

Hundreds of organizations signed a paper asking the Biden Administration to make the emergency act telehealth provisions permanent last year; however, the DEA seems to have other thoughts about drug and MAT safety and administration.

Hopefully, the DEA will listen to these organizations and create a rule that’s fair and flexible so that patients can get the treatment they need with the fewest barriers possible.

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