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The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a final rule that will improve how patients receive care for Substance Use Disorders (SUD) at Opioid Treatment Programs (OTPs) and increase the proliferation of telehealth as a mode of care. The rule makes some COVID-19-related flexibilities permanent, including allowing take-home doses of methadone, permitting OTPs to prescribe medication via telehealth without an initial in-person physical evaluation, and the removal of certain requirements for admission to an OTP. The rule only applies to providers working at certified OTPs, it doesn’t apply to all pharmacies or providers. What’s in the Rule?

• Removal of In-Person Requirement: Makes permanent the removal of the admissions requirement as a prerequisite to receive buprenorphine or methadone treatment by an OTP health professional.
• Buprenorphine: An OTP physician or other authorized health care professional under the supervision of a physician must determine that the patient can receive medical care via audio-visual or audio-only telehealth. The Rule states, “In the face of an escalating overdose crisis and an increasing need to reach remote and underserved communities, making the buprenorphine telehealth flexibility permanent is of paramount importance.” Again, this policy only applies to OTPs, it does not impact the Drug Enforcement Administration's (DEA) decision regarding tele-prescribing controlled substances outside of OTPs. Those specific flexibilities were extended only until December 31, 2024.
• Methadone: Changes the ordering dispensing processes for methadone by licensed OTP practitioners, including on unsupervised doses to the individual patient. The rule doesn’t allow the use of audio-only telehealth to prescribe methadone because methadone holds a higher risk profile for sedation. If audio-visual technology is not available, an audio-only device may be used to prescribe methadone but only when patient is in the presence of a licensed practitioner who is registered to prescribe and dispense controlled medications.
• Consent: Allows providers to obtain consent verbally or electronically, which must be documented. This change was made in acknowledgment of the increased use of telehealth and the difficulty in obtaining a signed, in-person consent when technology is involved.