Current flexibilities for opioid treatment can be extended without Congressional approval, a George Washington study contends
By Jason LangendorfApril 27, 2021
The federal government, which eased restrictions on medication treatment for opioid use disorder (OUD) during the COVID-19 pandemic, has the legal authority to extend that flexibility post-pandemic, according to a new report from George Washington University.
The report, released last week and funded by the Pew Charitable Trusts, indicates that the Substance Abuse and Mental Health Services Administration (SAMHSA) has the statutory power to make permanent the current flexibilities afforded to medication-assisted treatment (MAT) regulation—or even to issue new requirements that would help more people with OUD receive treatment in the future.
We know that opioid use disorder is a long-term chronic illness. And just because the pandemic goes away does not mean that someone’s opioid use disorder is going to magically disappear.”—Beth Connolly, Pew Charitable Trusts
“We do not need an act of Congress to expand access to treatment,” Beth Connolly, project director of Pew’s substance use prevention and treatment initiative, said of George Washington’s findings. “We’ve seen SAMHSA deftly navigate the expansion of access to treatment through the pandemic, and now we know that it is within their authority to make these changes permanent.”
The need has never been greater. Preliminary data from the Centers for Disease Control and Prevention (CDC) reports more than 87,000 overdose deaths in the United States in the year leading up to September 2020—the highest figure for a 12-month period on record and a continuation of the alarming upward trend during the COVID-19 pandemic. Judging from past figures, the majority of those lethal overdoses are likely to be a result of opioid misuse.
The Benefits of Methadone and Buprenorphine
Methadone and buprenorphine are considered the gold standard for MAT for OUD, easing withdrawal symptoms for people in recovery who otherwise might be driven to seek out illegal opioids. The concern regarding MAT—particularly methadone, a strictly regulated medication—is its potential for diversion (and thus more overdoses). For years, federal restrictions required people in recovery to make daily trips to a qualifying opioid treatment facility for the regulated administration of methadone.
Fears about widespread MAT misuse appear to be unfounded. According to the George Washington report, a recent study of anonymously surveyed patients who received methadone take-home doses since March found minimal reported levels of diversion.”
The pandemic forced a change in policy. In January 2020, the Secretary of the Department of Health and Human Services (HHS) declared COVID-19 a public health emergency, which led to the shutdown or heavy restriction of many treatment clinics and made daily visits for methadone treatment problematic or impossible for many. In March 2020, the previous regulations were loosened to allow patients to take home either a two- or a four-week supply of MAT for self-administration.
Fears about widespread MAT misuse appear to be unfounded. According to the George Washington report, a recent study of anonymously surveyed patients who received methadone take-home doses since March found minimal reported levels of diversion.
What’s Next for MAT?
In order to extend or expand greater access to medication for OUD, the report details three legal approaches SAMHSA could take:
- Make the current MAT regulation flexibilities permanent. This would allow states to continue current methadone prescribing practices without the request for exemptions.
- Issue new guidance, including potentially establishing new requirements that go beyond pandemic-period flexibilities.
- Publish new guidance tied to the separate opioid-specific public health emergency declaration (issued in October 2017), which must be regularly renewed for that guidance to stay in effect.
Connolly wouldn’t speculate on which approach is preferred or most likely to be followed by government officials, but she says multiple former and current regulations—including those around telehealth—will need to be considered to find “where the better path to permanency lies.”
“We know that opioid use disorder is a long-term chronic illness,” Connolly said. “And just because the pandemic goes away does not mean that someone’s opioid use disorder is going to magically disappear. So we have to keep in mind that we want to have this increased access available to people, for the very long term, so that we can support them in their recovery.”
Photo: Elsa Olofsson