Finalized Rules for the Prescribing of Buprenorphine through the use of Telehealth

On January 31, 2024, the Department of Health and Human Services (HHS) finalized rules for the prescribing of buprenorphine through the use of telehealth (rules first proposed in December 2022). In these final rules, opioid treatment programs (OTPs) will be able to use telehealth to prescribe buprenorphine without an in-person visit. It is important to note that these final rules are not in regard to using telehealth to prescribe a controlled substance in general. This is a very specific rule that applies to OTPs and the use of telehealth to prescribe buprenorphine with some additional applications specifically to methadone. The broader policy of using telehealth to prescribe controlled substances without an in-person visit (or meeting one of the narrow exceptions found in federal statute) still remains a temporary allowance through the end of 2024.

BACKGROUND

Readers may be aware that the COVID-19 public health emergency (PHE) activated one of the exceptions to using telehealth to prescribe a controlled substance without an in-person visit (or meeting one of the other narrow exceptions) which the Drug Enforcement Administration (DEA) oversaw during the pandemic. During the PHE, the Substance Abuse and Mental Health Services Administration (SAMHSA) also created a specific exemption for OTPs from having to conduct an in-person physical evaluation of patients who were being treated with buprenorphine if an OTP physician, primary care physician or authorized healthcare professional under the supervision of the program physician determined that such an evaluation could take place via audio-visual or audio-only telehealth. SAMHSA’s flexibility was extended for one year after the end of the PHE (to May 2024) or until a final rule is published. At this time, the waiver that the DEA oversees for prescribing of controlled substances has been extended to the end of 2024. This final rule only addresses the SAMHSA flexibility, as their regulatory authority in this area is limited to OTPs. SAMHSA developed the rule in consultation with the DEA and it addresses the use of telehealth for both buprenorphine and methadone use by an OTP.