The Substance Abuse and Mental Health Services Administration (SAMHSA) proposed new rules to expand access to treatment for opioid use disorder (OUD), in particular with methadone through opioid treatment programs (OTPs). The proposed changes will provide greater autonomy to OTP practitioners, as well as expand on telehealth and take-home flexibilities initially granted in connection with the nation’s COVID-19 public health emergency. Several proposals are aligned with recommendations in ASAM’s 2021 Public Policy Statement on Regulation of the Treatment of Opioid Use Disorder with Methadone and directly address items set forth in the federal Opioid Treatment Access Act, endorsed by ASAM (e.g., greater methadone take home/time in treatment rule flexibility and elimination of the “one year addicted” requirement for OTP admission). To read ASAM’s statement applauding SAMHSA’s release of this NPRM (via President Elect, Dr. Brian Hurley), click here.
Of note, allowing for the prescribing of methadone for OUD for pick up at pharmacies or allowing for telehealth initiation (i.e., without an in-person exam) of methadone or buprenorphine outside of the OTP patient context is beyond SAMHSA’s authority. We are still waiting to see what, if anything, Congress/DEA will do with respect to those matters. With that said, the continuation of the audio-video/audio-only telehealth flexibilities related to buprenorphine in this proposed rule for OTP patients bodes well for future DEA action in that regard.