Hey Tradeoffs readers, it’s hard to find someone these days who doesn’t have a friend or family member impacted by the opioid epidemic. That’s the focus of this week’s newsletter, and if you’re looking for more on the topic, do check out one of my all-time favorite books: Empire of Pain by Patrick Radden Keefe.

Should Remote Opioid Addiction Treatment Stay in the Mix?​

The national public health emergency ended last week, and Americans were supposed to come away with a clear picture of how policies that got upended during COVID would return to a post-pandemic normal.

But the long-term fate of one big pandemic-era policy remains unknown: whether clinicians will be allowed to continue treating opioid use disorder (OUD) entirely remotely. For certain patients with OUD, the use of telehealth during the pandemic was linked to greater rates of receiving medication-assisted treatment.

This past February, the federal Drug Enforcement Agency (DEA) proposed ending this flexibility. The ensuing backlash was immense — the agency received a record-breaking 38,000 public comments. 

Many clinicians and academics argued that requiring patients with OUD to see clinicians in person for treatment could decrease access to care and cause worse medical outcomes. 

On May 9, the DEA announced that it would extend the flexibility to November 11, but it could end for good after that. So I took a closer look at some data on the impact that this pandemic-era policy has had.

Remote treatment for opioid use disorder had similar outcomes to in-person visits 

A pair of papers on this topic offer one clear takeaway: While telemedicine is not necessarily better for this patient population compared to in-person options, it can be just as effective.

One of the papers, authored by Ruth Hailu and colleagues, found patients with OUD whose clinicians used a lot of telemedicine had similar outcomes to those whose clinicians used little telemedicine.

For example, patients whose clinicians frequently used telemedicine were just as likely to start and stay on medication-assisted treatment for their opioid use as those whose clinicians rarely used remote visits. Patients in those ‘low’ and ‘high’ telemedicine-use groups were also about equally likely to experience negative outcomes, like drug overdoses and injection-related infections.

The second study — in JAMA Psychiatry by Christopher Jones and colleagues — found that patients who received any remote OUD care saw their odds of having a fatal overdose drop by a third. In-person approaches had similar effects.

Though limited, research suggests that ‘diversion’ of treatment meds is not common

One frequent concern raised about making this policy permanent is that drugs used to treat OUD (like buprenorphine) will be diverted, or passed by the patient illegally to someone else. 

But such diversion isn’t that common — with fewer than 10,000 cases of diverted buprenorphine reported between 2002 and 2019. 

And since the DEA’s telehealth flexibility began, there has not been an increase in overdose deaths involving buprenorphine. That said, more research is needed to measure the extent and impact of diversion of OUD medications in the U.S.

Other options exist for increasing access to treatment

Even if the DEA does ultimately close the door on entirely-remote treatment, Congress recently opened another door to expanding treatment access. Lawmakers ended the so-called “X-waiver,” an arduous training requirement that many believe is a big reason that just five percent of medical providers are licensed to prescribe buprenorphine. 

With just one in four people who could benefit from medications like buprenorphine saying they actually receive them, there is plenty of work for policymakers and providers left to do.