Senators’ TREATS Act would make permanent the telehealth flexibilities for substance use disorder treatment
Washington, D.C. – U.S. Senators Sheldon Whitehouse (D-RI), Lisa Murkowski (R-AK), Mark Warner (D-VA), and Marsha Blackburn (R-TN) on Friday led a group of 11 senators in sending a bipartisan letter calling on the Drug Enforcement Agency (DEA) to extend COVID-era regulatory flexibilities that increase access to telehealth services. These rules have been a lifeline for many patients, particularly those in rural and underserved communities, as well as individuals managing mental health conditions, substance use disorders, and chronic illnesses.
“Telemedicine has proven to be an effective tool in reducing barriers to care, supporting those with the greatest need, and bridging the divide between patients and providers,” wrote the senators.
“As bipartisan senators committed to safeguarding public health and promoting equitable access to health care, we are concerned that the reported proposed restrictions could have significant unintended consequences, including disrupting access to treatment for substance use disorder,” added the senators. “We urge the DEA to continue working with stakeholders on a proposal that prioritizes the public health benefit for continued access to telemedicine, and finalize an additional temporary extension well before the December 31, 2024 deadline so that both providers and patients have certainty that there will be no gap in their ongoing care.”
The bipartisan letter urges the Biden Administration to extend the current flexibilities that safeguard access to necessary care while addressing the risks of prescription medication misuse, and recommends a final rule that creates no new barriers to care. The letter highlights that telemedicine has expanded access to life-saving treatments, particularly for opioid use disorder, mental health care, and chronic illnesses. The senators’ letter also stresses the importance of ensuring there is no gap in services when the current rules expire at the end of 2024.
The letter is also signed by Senators Ron Wyden (D-OR), Martin Heinrich (D-NM), Mark Kelly (D-AZ), Angus King (I-ME), Ben Ray Luján (D-NM), Jeff Merkley (D-OR), and Peter Welch (D-VT). Representatives Doris Matsui (D-CA) and Buddy Carter (R-GA) are leading a similar effort in the House.
Overdose deaths involving opioids rose to a peak of 84,181 Americans in 2022 before falling to 81,083 in 2023. Despite strong evidence that medication is the most effective treatment for opioid use disorder, only one in five Americans with opioid addiction receive medication treatment that could help them quit and stay in recovery.
In November 2023, Whitehouse, Murkowski, Warner, and Blackburn reintroduced the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act to increase access to medication for substance use disorder through telehealth. The bipartisan legislation will waive regulatory restrictions for accessing care, preserving flexibilities put in place to save lives during the COVID-19 pandemic.
During the COVID-19 Public Health Emergency, the DEA and the Department of Health and Human Services temporarily removed the in-person exam requirement for prescribing medication via telemedicine for people with opioid use disorder. Telehealth flexibilities helped a broad range of patients – including veterans, those living in rural areas, people experiencing homelessness, individuals in the criminal justice system, and racial and ethnic minorities – access treatment. The flexibilities are set to expire on December 31, 2024.
The TREATS Act would make the changes permanent, allowing providers to waive the in-person visit requirement and instead use audio-only or audio-visual telehealth technology. The TREATS Act has 20 bipartisan cosponsors in the Senate.
Recognizing the devastating toll of addiction in Rhode Island and across the nation, Whitehouse in 2016 authored the Comprehensive Addiction and Recovery Act, the bipartisan law guiding the federal response to the opioid addiction crisis.
The text of the letter is below and a PDF is available here.
October 11, 2024
The Honorable Joseph R. Biden, Jr.
President
The White House
1600 Pennsylvania Ave. NW
Washington, D.C. 20500
Dear President Biden:
We write to express our serious concerns regarding initial reports about the Drug Enforcement Administration’s (DEA) draft proposed rule that would impose substantial limitations on telemedicine prescribing of controlled substances. We appreciated the DEA’s extension of the telemedicine flexibilities through the end of the year while developing this proposal, but are concerned that the new policies would significantly restrict access to necessary and life-saving treatments. These restrictions would be detrimental to patients and a barrier to accessing care. As bipartisan senators committed to safeguarding public health and promoting equitable access to health care, we are concerned that the reported proposed restrictions could have significant unintended consequences, including disrupting access to treatment for substance use disorder. We urge the DEA to continue working with stakeholders on a proposal that prioritizes the public health benefit for continued access to telemedicine, and finalize an additional temporary extension well before the December 31, 2024 deadline so that both providers and patients have certainty that there will be no gap in their ongoing care.
Telemedicine has been instrumental in expanding access to health care, especially for individuals in rural and under-resourced areas. The flexibility afforded by telemedicine has been particularly important in providing access to essential medications, including those for mental health conditions, substance use disorders, and chronic illnesses. Telemedicine has proven to be an effective tool in reducing barriers to care, supporting those with the greatest need, and bridging the divide between patients and providers. At its pandemic peak, telemedicine represented 40 percent of mental health and substance use disorder outpatient visits and remains highly utilized, representing 36 percent of all outpatient visits of this type. With over 57 million adults in the United States experiencing mental illness each year, and approximately two million individuals suffering from opioid use disorder, the need for accessible and effective treatment options is undeniable. The pandemic telemedicine flexibilities increased access to medications, like buprenorphine, for vulnerable Americans with opioid use disorder, improved addiction treatment retention, and reduced overdoses. A disruption in access to essential and life-saving medication and services will be detrimental to the health and safety of patients everywhere.
According to the Centers for Disease Control and Prevention, there were an estimated 107,543 drug overdose deaths in the United States in 2023, including over 81,000 from opioids. Americans face barriers to accessing substance use disorder and mental health treatment services, particularly in rural and under-resourced communities. More than half of U.S. counties do not have a psychiatrist, including nearly three-quarters of rural counties. Rural counties also face additional provider shortages, with many lacking access to psychiatrists, psychologists, clinical social workers, and other behavioral health providers. Telemedicine flexibilities have ensured that patients receive timely and necessary care, at a time and location that is convenient for them. These challenges underscore the importance of maintaining flexibilities that increase access to treatment and services.
We understand the DEA’s responsibility to address the risks associated with prescription drug diversion and abuse and to ensure that prescriptions for controlled substances are issued for a legitimate medical purpose. However, it is vital that any new regulations do not erect barriers to necessary, life-saving care. It is essential to strike a balance between regulatory oversight and accessibility, ensuring that patients who benefit from telemedicine continue to receive the care they need without undue impediments. Indeed, Congress has directed the DEA to allow telemedicine, including through a special registration that would strike this balance, both originally in the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 as well as in law again in the SUPPORT for Patients and Communities Act in 2018.
We appreciate your attention to this important matter and look forward to a constructive dialogue on how best to address these concerns.
Sincerely,
