ASHP met with Drug Enforcement Administration (DEA) officials, clinicians, and representatives of medical and pharmacy groups to discuss access barriers to treatment with medications for opioid use disorder. The roundtable came as DEA is working to finalize proposed rules on telehealth prescribing of medications, including buprenorphine. Discussion during the meeting was broader than telehealth, centering on improving access to buprenorphine and methadone following the removal of the X-waiver requirements.
In response to questions about increasing buprenorphine access following the removal of the X-waiver, ASHP suggested the DEA consider options for providing additional regulatory flexibility related to buprenorphine prescribing via telehealth. Specifically, ASHP suggested that with an opioid-related public health emergency declaration, DEA could continue to allow the flexibility for initiation of buprenorphine treatment without an in-person visit. ASHP also flagged concerns around liability for prescribers and dispensers related to volume of buprenorphine prescribing. With the recent national opioid settlement with wholesalers, some pharmacies are already being flagged simply for dispensing buprenorphine. Such undue scrutiny is likely to have a chilling effect on the number of providers willing to either begin or expand buprenorphine prescribing and dispensing.
Regarding DEA’s questions related to methadone treatment, ASHP noted that daily visits to opioid treatment programs (OTPs) are onerous, even for patients who live near one. In many cases, patients struggle to find capacity at OTPs. Increasing the availability of take-home doses and loosening registration requirements for OTPs could significantly improve access to these programs.
ASHP is planning to submit comments on DEA’s proposed rules on telehealth prescribing of controlled substances and telehealth prescribing of buprenorphine by the March 31 deadline. We strongly encourage members to submit feedback, questions, or concerns to ASHP to assist in the development of our written comments on the proposed rule. Please send any input to Jillanne Schulte Wall at [email protected] by March 25.
