As we anticipate the end of the COVID-19 Public Health Emergency, there is uncertainty over how it will affect telemedicine addiction treatment.
Since the start of the pandemic in the U.S. in 2020, there has been a massive increase in online healthcare. This has been partly due to greater need for and acceptance of virtual care by the public during this time. In the case of telemedicine treatment for substance use disorders, though, there was another reason for the surge in availability. The growth in online addiction care was supported by greater flexibility in how regulations like the Ryan Haight Act were enforced. What does the end of the pandemic and the COVID-19 Public Health Emergency mean for virtual addiction treatment?
A brief explanation of the Ryan Haight Act
First, know that the Controlled Substance Act of 1970 sorts regulated substances into five schedules, from Schedule I (the most restricted and controlled) to Schedule V (least restricted, considered lowest potential for misuse). Buprenorphine is a Schedule III controlled substance.
The Ryan Haight Act is an amendment to the Controlled Substances Act. Its full name is the “Ryan Haight Online Pharmacy Consumer Protection Act of 2008.” It was named after Ryan Haight, an 18-year-old who died of an overdose after taking Vicodin he got from an online doctor, delivered to his home by an online pharmacy. The act was intended to defend the public against online doctors, retailers, and pharmacies who were carelessly selling controlled substances online, without regard for whether they were medically necessary or how they would be used. The common term for a business or doctor who sells and prescribes like this (overprescribing without due care for patients’ health and well-being) is a “pill mill.”
The part of the Ryan Haight Act that most impacts telehealth companies like Workit Health is the requirement that a clinician must conduct an in-person medical examination of a patient in order to prescribe a controlled substance. Remember, buprenorphine—the main ingredient in Suboxone and other buprenorphine/naloxone medications that treat opioid use disorder—is a controlled substance. So in the early days of Workit Health (pre-2020), members would travel to one of our brick-and-mortar clinic locations for their first appointment, and then the rest of their treatment would move online, via our app.
The Ryan Haight Act includes other safeguards, too, like saying that pharmacies must disclose their physical location and the license numbers of their pharmacists to do business over the internet, making it a crime to advertise online for the illegal sale of a controlled substance, and increasing the penalties for violating the act to up to 20 years in prison. These are all important, but when people talk about Ryan Haight and telemedicine addiction treatment, they are usually referring to the requirement for an in-person medical exam.
How did the COVID-19 pandemic change the regulations?
When they passed the Ryan Haight Act, lawmakers included some exceptions to the in-person requirement. One of these says that the Secretary of Health and Human Services can suspend the in-person requirement when a Public Health Emergency (PHE) is declared. The PHE around COVID-19 was declared on January 31, 2020.
The PHE meant that clinicians had the flexibility to conduct their medical examinations completely over the internet, instead of in-person. Advances in technology meant that doctors could have regular, live video appointments and provide high-quality care online, making this a reasonable and ethical option, as well as being legal while the PHE is in effect. This has allowed people with opioid use disorder to receive treatment entirely online and still get a valid prescription for buprenorphine. For Workit Health, it has offered our members the chance to receive treatment even if they don’t have transportation, child care, or time off work to travel to a physical clinic for that first appointment. This has been nothing short of revolutionary, lowering the barriers to treatment for people who need it so that they can get help right away when they’re ready. Research shows that telemedicine treatment for opioid use disorder is as effective as in-person treatment.
What happens after the Public Health Emergency is over?
A PHE declaration doesn’t last forever. It ends either when the Secretary of Health and Human Services declares that it’s over or after 90 days, whichever happens first. So why is the PHE still in effect three years after it was declared? Because it has been renewed every 90 days since it was first declared. On January 30, 2023, the Biden Administration announced its intention to end the PHE in May of this year.
Now the medical community is looking ahead at what will happen with telemedicine addiction care after the PHE ends. There is a major push among doctors and health organizations to amend the Ryan Haight Act, allowing telemedicine treatment for opioid use disorder without the in-person exam. Proponents of this kind of amendment (including Workit Health) point out that there has been another PHE, which has been steadily renewed since October 26, 2017—the opioid crisis. Allowing telemedicine providers the flexibility to treat opioid use disorder has been pivotal in saving lives, preventing relapse and overdose, and helping people achieve long-term recovery.
To be transparent, though, there are also people fighting against changing the Ryan Haight Act, who want to limit online access to medication-assisted treatment.
At this time, bills have been introduced to Congress that would amend the Ryan Haight Act to exempt telemedicine treatment for opioid use disorder from the in-person requirement. The Substance Abuse and Mental Health Services Administration, which is part of the Department of Health and Human Services, publicly announced support for this kind of amendment. And there is already progress in making buprenorphine treatment more available, as lawmakers recently removed the requirement that clinicians have a special waiver (DATA-waiver or X-waiver) from the DEA in order to prescribe buprenorphine.
However, if the PHE were to end today, the requirement for an in-person examination would probably go back into effect. New patients of telemedicine providers would need to go to a physical location for one appointment before they could start receiving buprenorphine. They could then continue their treatment online.
Workit Health is exploring options and making plans
Workit Health is currently exploring options for how we can best serve our members after the PHE ends. Our mission is to improve the lives of people with substance use disorders, making effective, science-based treatment available and accessible to those who need it. We will still be guided by that, even if the Ryan Haight Act goes back into full effect.
We are advocating with lawmakers for the permanent removal of the in-person requirement, but we’re not blindly relying on that hope. We are researching how we can see new members in physical clinic locations, where those locations should be, and how to reduce the barriers our members face in getting to that first appointment.
The end of the PHE will be a new challenge for telemedicine, but it will not stop the progress we have made.