Assessment of State and Federal Health Policies for Opioid Use Disorder Treatment During the COVID-19 Pandemic and Beyond

Abstract

IMPORTANCE Federal and state governments implemented temporary strategies for providing access to opioid use disorder (OUD) treatment during the COVID-19 pandemic. Advocates hope many of these policies become permanent because of their potential to expand access to care. OBJECTIVE To consider the multitude of ways access to and utilization of treatment for individuals with OUD might have been expanded by state and federal policy so researchers can do a better job evaluating the effectiveness of specific policy approaches, which will depend on the interaction with other state policies. EVIDENCE REVIEWWe summarize state-level policy data reported by government and nonprofit agencies that track health care regulations, specifically the Kaiser Family Foundation, Federation of State Medical Boards, American Association of Nurse Practitioners, American Academy of Physician Assistants, and the National Safety Council. Data were collected by these sources from September 2020 through January 2021. We examine heterogeneity in policy elements adopted across states during the COVID-19 pandemic in 4 key areas: telehealth, privacy, licensing, and medication for opioid use disorder. The analysis was conducted from March 2020 through January 2021.FINDINGS This cross-sectional study found that federal and state governments have taken important steps to ensure OUD treatment availability during the COVID-19 pandemic, but few states are comprehensive in their approach. Although all states and Washington, DC have adopted at least 1 telehealth policy, only 17 states have adopted telehealth policies that improve access to OUD treatment for new patients. Furthermore, only 9 states relaxed privacy laws, which influence the ability to use particular technology for telehealth visits. Similarly, all states have adopted at least 1 policy related to health care professional licensing permissions, but only 35 expanded the scope of practice laws for both physician assistants and nurse practitioners. Forty-four states expanded access to initiation and delivery of medication for OUD treatment. Together, no state has implemented all of these policies to comprehensively expand access to OUD treatment during the COVID-19 pandemic. CONCLUSIONS AND RELEVANCEWith considerable policy changes potentially affecting access to treatment and treatment retention for patients with OUD during the pandemic, evaluations must account for the variation in state approaches in related policy areas because the interactions between policies may limit the potential effectiveness of any single policy approach.

National trends in buprenorphine prescribing before and during the COVID-19 pandemic

“…The COVID-19 pandemic prompted numerous policy changes in the treatment delivery system for OUD at both the federal and state levels. These changes include flexibilities around buprenorphine prescriptions via telehealth, including increased reimbursement and coverage for telehealth services, increase in the number of days of take-home medications and home delivery options for patients, relaxed licensing laws for providers among others ( Pessar, Boustead, Ge, Smart, & Pacula, 2021 ). Although how each of these specific policies have impacted initiation and retention of buprenorphine treatment for OUD is unclear, they might have played a role in keeping buprenorphine prescriptions steady during the pandemic, especially during the later periods.…”

Medicaid professional fees for treatment of opioid use disorder varied widely across states and were substantially below fees paid by medicare in 2021

“…The COVID-19 pandemic drove federal and state changes in services related to OUD treatment in Medicaid and Medicare, including that Medicare as well as Medicaid programs in 42 states and the District of Columbia implemented payment parity for at least some telehealth services compared to face-to-face services by January 2021 [ 25 ]. Thus the data collected for this study likely applies to a more flexible set of services that originally intended when payment rates were set.…”

Estimating the impact of the COVID-19 pandemic on rising trends in drug overdose mortality in the United States, 2018-2021

“…[32] Some states required telehealth visits with Medicaid or private insurance to be paid at the same rate as analogous in-person visits, allowed for behavioral telehealth with waving requirements on prior in-person contact, relaxed state privacy laws, and allowed NPs and PA to obtain buprenorphine prescribing waivers. [ 33 , 34 ] Further studies are needed to estimate the impact of each intervention on access to care and drug mortality changes.…”