New telehealth regulations to provide path for opioid-use-disorder treatment

Possible changes to telehealth regulations could make it easier for people to access opioid-use-disorder treatment. The change is expected to boost accessibility for rural communities, but local advocates say other strategies are also necessary to address opioid use in Indiana.

The Drug Enforcement Administration proposed new rules that will change the way medication can be prescribed through telehealth appointments. The change would increase access to OUD treatment by allowing healthcare providers to prescribe medication for treatment without seeing the patient in person.

That policy was established at the start of the coronavirus pandemic, and the new regulations would make the change permanent. The new rules would also restrict prescriptions for some addictive medications if a healthcare provider has not seen a patient in person.

Amnah Anwar, the program director for the Upper Midwest Telehealth Resource Center (UMTRC), said the program has recently seen a spike in questions about how OUD treatment would change once the COVID-19 telehealth allowances expired. She said telehealth helps patients and providers avoid a lag in treatment that would happen if they had to transition back to in-person treatment plans, but the UMTRC has concerns about the DEA’s proposed rules.

“These rules are overly restrictive and will put many of these patients at risk,” Anwar said.

Research indicates OUD treatment through telehealth is as effective as in-person treatment for many patients. A 2022 study by Jones, Shoff, Hodges, Blanco, Losby, Ling and Compton published in “JAMA Psychiatry” found telehealth treatment grew massively during the pandemic, and in some cases, it improved patient retention and reduced the odds of a medically treated overdose for patients.

Studies looking at telehealth treatment before the pandemic support these findings. A 2021 study by Vakkalanka, Lund, Ward, Arndt, Field, Charlton and Carnahan published in the “Journal of General Internal Medicine” looked at data from 2008 through 2017. It also found patient retention was higher among those receiving OUD treatment through telehealth.

In addition to improving patient retention, healthcare providers are hoping that providing a new option for OUD treatment will improve accessibility — especially for people in rural areas. Anwar said making telehealth accessible can remove barriers to treatment.

“There are transportation issues. There are the shortages of health providers or specialists in rural areas. So those services could be provided via telehealth to rural communities,” Anwar said.

According to the Health Resources and Services Administration, 62 counties out of the 92 in Indiana are eligible for rural health funding, indicating large areas in those counties are rural.

The new regulations are also relevant for areas of Indiana with elevated opioid use. According to the CDC, in 2020, the national average rate of overdose deaths per 100,000 members of a state’s population was 29. Indiana’s average death rate was 36.7; the state ranked 13th for the highest death rate.

Dr. Jean Marie Place, the director of community research and administration for the Addictions Coalition of Delaware County (ACDC), said new telehealth regulations could open another option for OUD treatment, but that other options will still be necessary.  

“Addiction really needs a multidisciplinary approach, a multi-pronged approach,” said Place. “You have to address it from so many different areas.”

Place described addiction as both a medical and social problem. She said the ACDC works on projects for both, including efforts to establish a crisis center in Muncie. The crisis center is meant to connect people struggling with addiction and mental health issues with resources like rehab centers and domestic violence shelters.

According to a press release from the city of Muncie, the crisis center is set to open by the end of 2023. Muncie Mayor Dan Ridenour described the center as a place that will give people a chance.

“We have challenges in our community, and we're trying to come up with steps to solve them,” Ridenour said. “We've got the crisis center that started. We've got funding for that for several years. We're looking at additional funding.”

The funding provided by the city and obtained through grants and settlement funds from opioid lawsuits will be used to open and operate the crisis center. The funding is expected to last through 2026.

Justina Pfeffer is a re-entry peer recovery coach for the Integrated Reentry and Correctional Support program in Blackford and Delaware County jails. She said there are many pathways to recovery and having options helps people decide what they want their life to look like moving forward.

“We believe that as long as there's breath in your body, there's still hope,” Pfeffer said. “We just want to keep you alive.”

Local organizations like Recovery Café Muncie and the Muncie Folk Collective are also working to address the danger of opioids by distributing naloxone and fentanyl testing strips to reduce the number of overdoses in the area.

Misty Wilson, a Recovery Café member, has participated in peer-led support groups at Recovery Café Muncie in her own recovery journey. She said the café is meant for everyone, and it is especially helpful for those recovering from substance use disorder and mental health challenges.

“It’s been helping me with my recovery. Because I think without it, I would struggle a lot more than I did,” Wilson said. “If it wasn’t for them, I think I would be back where I was.”

The proposed telehealth regulations are expected to be adopted after the COVID-19 public health emergency ends on May 11. For people looking for treatment options, Indiana’s state government has compiled a list of opioid treatment programs across the state.

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