Buprenorphine Prescribing via Telehealth Delayed

Two federal agencies have delayed implementation of two rules that would have allowed clinicians to prescribe buprenorphine for opioid use disorder (OUD) for up to 6 months without an in-person visit, stating that more time is needed to review whether the rules are lawful.

The rules — “Expansion of Buprenorphine Treatment via Telemedicine Encounter” and “Continuity of Care via Telemedicine for Veterans Affairs Patients” — were initially proposed in March 2023, as reported by Medscape Medical News, and were revised after public input.

The rules were due to go into effect in mid-February, but an executive order freezing agency regulatory work halted their implementation. Now, new officials at the Health and Human Services department and the Drug Enforcement Administration (DEA) have delayed the effective date to December 31.

Clinicians were somewhat crestfallen. While the final rule was not perfect, it would have offered certainty, said Linda Hurley, CEO of CODAC Behavioral Healthcare, a Rhode Island–based nonprofit treatment program for those with OUD. With the final regulation, treatment providers would “no longer have this anxiety about what’s going to happen next,” she told Medscape Medical News.

Clinicians and programs can still offer initial 30-day buprenorphine prescriptions by audio or video calls through December 31, as allowed under a COVID-pandemic era temporary rule that has been extended three times, Hurley noted.

The American Society of Addiction Medicine (ASAM) also noted that the temporary rule is still in effect and said it supported the final regulations that have now been delayed.

“For people with OUD who are in a crisis and unable to physically reach a clinic, the ability to initiate buprenorphine for OUD via telemedicine can be lifesaving,” Brian Hurley, MD, MBA, ASAM president, said in a statement to Medscape Medical News. “This telemedicine flexibility has proven to be a vital tool for clinicians on the frontlines, and ASAM applauds the Administration’s efforts to make this flexibility permanent.”

However, the American Psychiatric Association (APA) raised concerns that “this delay in implementation may cause unnecessary confusion and interruptions in care.” In a statement to Medscape Medical News, the APA said that in the midst of a mental health and substance use crisis, the association “encourages the administration to implement regulations that improve access to life saving treatments rather than imposing limitations on the practice of medicine.”

The final rule would allow a prescriber — after reviewing a patient’s prescription drug monitoring program data — to prescribe an initial 6-month supply of OUD medications such as buprenorphine. Additional prescriptions can be issued under other forms of telemedicine as authorized under the Controlled Substances Act or after an in-person medical evaluation. The regulation also would require pharmacists to verify a patient’s identity before filling a prescription.

That requirement drew some protests in the most recent public comments about the rules. A pharmacist said the verification requirement would mean that a family member or friend could not pick up a prescription for a patient who had work conflicts or transportation issues. That “will result in missed doses and serious adverse effects,” said the pharmacist, noting that the identity verification would not prevent diversion.

The American Pharmacists Association (APhA) also raised concerns in a public comment that pharmacists would have to contact the prescriber on every buprenorphine prescription to verify whether the prescription was made in an in-person visit or via telemedicine. That will be a burden to pharmacists and “could result in delays in the patient receiving their buprenorphine,” wrote the APhA.

The organization also noted that the rules had failed to adequately recognize that pharmacists in 10 states had prescribing privileges.

“APhA strongly recommends DEA clarify that DEA-registered pharmacists can prescribe and dispense buprenorphine under this final rule or risk causing irreparable harm to patient access to lifesaving medication,” wrote the group. 

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in many health and science publications, including Smithsonian.com. You can find her on X @aliciaault and on Bluesky @aliciaault.bsky.social.