SAMHSA Issues Additional Guidance on OUD Treatment, Privacy, Telehealth During COVID-19 Pandemic

Yesterday the Substance Abuse and Mental Health Services Administration (SAMHSA) released further guidance on the treatment of opioid use disorder (OUD) during the COVID-19 pandemic, specifically with respect to privacy and sharing of medical records related to substance use treatment. It has also clarified, with FAQs, guidance it released earlier this week about opioid treatment programs’ (OTPs’) ability to provide medications via telehealth during the pandemic.

Regarding privacy, SAMHSA has acknowledged that treatment providers may not be able to obtain written patient consent for disclosure of substance use disorder records during the pandemic. Therefore, “[t]he prohibitions on use and disclosure of patient identifying information under 42 C.F.R. Part 2 would not apply in these situations to the extent that, as determined by the provider(s), a medical emergency exists” and “patient identifying information may be disclosed by a Part 2 program or other lawful holder to medical personnel, without patient consent, to the extent necessary to meet a bona fide medical emergency in which the patient’s prior informed consent cannot be obtained,” the guidance states.

The guidance also includes a reminder that the regulations require programs to “document certain information in their records after a disclosure is made pursuant to the medical emergency exception.”

In its FAQs, SAMHSA noted that under 42 CFR Section 8.11(h), it has chosen to exempt OTPs from certain requirements. For the duration of the national emergency, OTPs are exempt “from the requirement to perform an in-person physical evaluation (under 42 C.F.R. § 8.12(f)(2)) for any patient who will be treated by the OTP with buprenorphine if a program physician, primary care physician, or an authorized health care professional under the supervision of a program physician, determines that an adequate evaluation of the patient can be accomplished via telehealth.”

However, this exemption does not apply to new OTP patients treated with methadone. These patients must still be evaluated in person.

Other key points in the SAMHSA FAQs include the following:

• OTPs may use telehealth, including care provided over the telephone, to continue treatment of existing OTP patients who use methadone or buprenorphine.
• Health care professionals who are qualified with a waiver under the Drug Addiction Treatment Act of 2000 (“DATA waiver,” “X waiver”) and who are working outside the context of an OTP may treat new and existing patients with buprenorphine via telehealth.
• OTPs may dispense either methadone or buprenorphine medications based on a telehealth evaluation. They may provide medication under a blanket exception: up to 14 doses for clinically less stable patients and 28 doses for clinically stable patients.
• Mid-level practitioners in OTPs can administer and dispense medications for treating OUD without the direct supervision of an OTP physician, if the mid-level practitioner is “licensed under the appropriate state law and registered under the appropriate state and federal laws to administer or dispense opioid drugs.” However, the OTP medical director still must assume responsibility for administering all medical services provided by the OTP.

(Image: iStock/Poike)

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Despite Effectiveness, Buprenorphine Remains Underprescribed

Experts say buprenorphine is the ideal medication for opioid addiction—the partial agonist satisfies cravings without the same level of euphoria that drives drug-seeking behavior. Yet, the medication is underused and underprescribed, according to experts who spoke with Psychiatric News.

According to statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA), there are just 31,862 physicians certified to prescribe buprenorphine—and 40 percent of these physicians do not prescribe buprenorphine at all.

A recent Psychiatric News article explored several factors that may deter physicians from prescribing the medication and create access challenges for patients. To address this access problem, APA supports incrementally expanding the number of patients that certified buprenorphine providers are permitted to treat at one time.

“I like to think of buprenorphine as a pharmacological platform that takes away withdrawal,” said John Renner, M.D., vice chair of the APA Council on Addiction Psychiatry and president of the American Academy of Addiction Psychiatry (pictured above). “It does not resolve whatever problems led an individual to seek out drugs in the first place, but what does change is that the patient’s life is not dominated by drug-seeking. The pharmacological platform makes recovery possible.”

While buprenorphine is a highly effective treatment for opioid addiction, experts agreed that it should be prescribed as part of a total addiction treatment plan including participation in 12-step recovery and/or psychotherapy.

For more about buprenorphine prescribing and APA training to receive the waiver necessary to prescribe, see the Psychiatric News article “Why Aren’t More Physicians Prescribing Buprenorphine?”