SAMHSA encourages telehealth for substance use disorder patients

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Late last week the Substance Abuse and Mental Health Services Administration (SAMHSA) issued guidance encouraging the use of telehealth for substance use disorder (SUD) patients during the COVID-19 pandemic national emergency period. 

Telehealth SUD
On March 20, 2020, SAMHSA offered recommendations to decrease COVID-19 transmission risks while addressing the behavioral health needs of SUD patients. In particular, SAMHSA is “advising that outpatient treatment options be used to the greatest extent possible” and that inpatient treatment be reserved for patients with life-threating mental disorders.  In addition, SAMHSA “strongly recommends” the use of telehealth or telephonic services for evaluation and management, such as initial evaluations for buprenorphine opioid use disorder (OUD) treatment and for implementing individual or group therapies for mental or substance use disorders.

SAMHSA also published general guidance March 20 recommending use of telemedicine, including telephone, where possible, and noting the loosening of Medicare and state telehealth restrictions [see also].

Buprenorphine and Methadone Treatment in OTPs
On March 19, 2020, SAMHSA published FAQ guidance exempting opioid treatment programs (OTPs) from the physical examination requirement for new OUD patients who are treated with buprenorphine (but not methadone).

Federal regulations require a complete physical evaluation within 14 days following a patient’s admission to an OTP. SAMHSA is exempting OTPs from this in-person evaluation requirement for new patients who are treated with buprenorphine if a program physician, a primary care physician, or an authorized practitioner under the supervision of a program physician determines that an adequate evaluation of the patient can be performed via telehealth. This exemption applies during the COVID-19 pandemic national emergency period and is limited to new patients who are treated with buprenorphine.

SAMHSA’s exemption specifically excludes new patients who are treated using methadone, so an in-person physical evaluation will continue to be required for those new patients.

SAMHSA’s guidance clarifies that DEA-registered practitioners working in an OTP program are allowed to continue treating existing OTP patients with methadone or buprenorphine via telehealth (including telephone) so long as applicable standards of care are satisfied and the treatment is in accordance with SAMHSA’s March 16 guidance, which allows states to request blanket exceptions permitting stable patients to receive 28 day supplies and less stable patients to receive 14 day supplies.

Practitioners with a DATA 2000 waiver and not working within OTPs are also allowed to continue treating new and existing patients with buprenorphine.

42 CFR Part 2 Guidance
Also last week, SAMHSA issued guidance on the medical emergency exception to the 42 CFR Part 2 restrictions on the use or disclosure of patient identifying SUD information [see also"SAMHSA issues guidance on disclosure of substance use disorder patient information"].

For a collection of SAMHSA links to COVID-19 guidance and resources, please see the SAMHSA website.

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