Biden admin extends pandemic-era flexibilities on opioid use treatments

The Biden administration is moving to make permanent the pandemic rules that allowed take-home drugs to help fight opioid addiction.

Why it matters: The proposed rule from HHS would make it easier for patients with opioid use disorder to access drugs like methadone for home use and for providers to prescribe them via telehealth for patients with opioid use disorder.

• Before the COVID-era changes, federal regulations often required those seeking treatment to go in-person daily to receive medication, according to the Pew Charitable Trusts.

The big picture: Tuesday's moves come amid a broader administration push to address the opioid crisis — and while the Food and Drug Administration is reviewing whether to make a nasal spray for reversing opioid overdoses available without a prescription.

• More than 100,000 people in the U.S. died from overdoses last year, according to provisional data released earlier this year by the CDC. That's more than any year on record.
• But in many cases, drugs for treating opioid abuse aren't reaching most high-risk patients, potentially widening gaps in care.

Catch up quick: The Substance Abuse and Mental Health Services Administration, or SAMHSA, at the outset of the pandemic, relaxed restrictions on take-home methadone — and later buprenorphine in 2021 — letting clinics offer more doses to patients deemed able to safely handle the medication.

• In this respect, the pandemic provided a test case to demonstrate that loosening regulations on methadone was safe for patients and communities, per Undark Magazine.
• An August report from NIH found those with opioid use disorder who received telehealth services had a lower risk of overdosing, and the expanded access to medication like methadone and buprenorphine helped people continue their treatment.
• The Health and Human Services Department said this month that since last fall, the number of health care providers with waivers to prescribe buprenorphine for opioid use disorder increased by 19% and that naloxone prescriptions filled in pharmacies has increased by 37%.

Details: The federal government is also looking to remove a requirement that prohibits a treatment program from admitting people with less than a year of an opioid addiction, opting instead for consideration of opioid use.

• The proposed rule would widen the scope of who is able to prescribe treatment drugs to permanently include any provider licensed to dispense medications such as physician assistants or nurse practitioners.

What they're saying: "Enabling creative, effective strategies, such as telemedicine, is critical to reducing the number of overdose deaths in our country, particularly in underserved areas, and ending the overdose crisis," a group of attorneys general from 44 states and the District of Columbia said in a letter last month calling for the extension.

In a Tuesday Brookings Institution briefing, HHS Secretary Xavier Becerra acknowledged the limitations of the federal agency in moving quicker with prevention strategies to target overdose deaths.

• An example is the decriminalization of fentanyl test strips, Becerra said, which Pennsylvania recently legalized.
• Ohio could be next after the House passed a bill in late November with overwhelming bipartisan support.

Between the lines: The telehealth flexibilities could be particularly important for rural areas which were particularly hard hit by the opioids but less well equipped to have accessible resources.

• While funds from settlements with opioid manufacturers and distributors have started to flow to states grappling with the effects of the crisis, rural areas are likely see far less than they actually need for their response, KHN reported this week.

Yes, but: "We have a nationwide public health system that relies on that patchwork of states, territories and tribal governments to do it right," Becerra said.

• "And if it's not done right, then within those seams, people fall through the cracks."