DEA Telehealth Guidance: A Step Backward
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To whom it may concern:
We are writing regarding the recent Drug Enforcement Administration guidance around Rules for Permanent Telemedicine Flexibilities. We write to inform you of the harm that this guidance will bring to some of our most vulnerable community members.
During the COVID Public Health Emergency, we were able to see the benefit of telemedicine services specific to people with opioid use disorder (OUD). Our ability to initiate and continue people on medications for opioid use disorder (MOUD) like buprenorphine for treatment of OUD was expanded significantly, and as a result, we have seen an incredibly positive response to this approach, especially among the unhoused populations, tribal members, and Medicaid-covered individuals we serve.
This guidance, requiring individuals to make an in-person appointment in the 30 days post-initiation of medication, will prevent the people who would benefit the most from these treatments from receiving help. It reinforces outdated practices that have proven ineffective in addressing our national overdose crisis.
The rules require that an individual receive either an in-person evaluation prior to referral to an addiction specialist for initiation of medication, or they can initiate medication and then receive an in-person visit in the following thirty days to allow for continuation of the prescription.
While initiating an in-person visit in the month following a virtual visit may sound easy or reasonable to many policymakers, the fact is that many of the people we serve are struggling with circumstances that can make this exceedingly difficult and highly unlikely. The average wait to schedule a visit with a primary care provider in the United States is 26 days. Nearly 100 million Americans lack a Primary Care Provider.
We know that the longer people are made to wait for an appointment, the more likely it is that they will need to reschedule. This proposed rule shift appears to ignore the data around this dynamic.
In addition to these universal logistical issues, many individuals we serve lack the financial means to afford flexibility in their duties at work, with their children, at school, or to obtain transportation. For the individuals we serve in rural areas, we are often the only option that prevents them from traveling long distances — often several hours round-trip — to get an in-person visit.
When these circumstances coincide with the already-ubiquitous stigma, lack of resources, and difficulty in navigating the convoluted differences with benefits and care, the result is that people simply do not access anything. They specifically do not connect with a medication that shows the potential to decrease the risk of overdose by 80%, one of the most effective tools we have in efforts to address our shared overdose crisis. They are at significant risk of becoming yet another preventable statistic, joining the 107,000 children, parents and friends that lost their lives to preventable overdose death in 2021.
It does not have to be this way. It shouldn’t be this way.
These medications represent the pathway toward recovery that so many need, and delaying or putting roadblocks in the way of their utilization in the name of managing risk is absurd when our drug supply is comprised entirely of fentanyl, fentanyl analogues, and now, nitazines and other dangerously powerful substances.
Our approach to substance use issues in the United States has historically served commercially insured individuals and those with the ability to pay to make our system work more effectively in a supportive, public health approach. This proposed guidance ignores those who suffer most, implementing a punitive approach with administrative barriers that will be insurmountable for many. This guidance assures continued inequity in access to care.
We need to prevent profiteering off the suffering of individuals, families, and communities, and there have been some high-profile examples of this among virtual care companies. We support the DEA in working to establish safe and effective guidelines for this practice, however this guidance from the DEA does nothing to prevent the underlying issues with these practices or stop their continuation. It does, however, significantly impair our ability to address the unprecedented level of suffering in our communities.
We stand ready to assist in addressing this glaring misstep and work toward a solution that protects the most vulnerable individuals and communities affected by substance use.
Sincerely,
The Undersigned