Telehealth News

MAT Act Would Remove Waiver, Boost Telemedicine Use in SUD Treatment

Congress is mulling legislation that would remove a cumbersome waiver process and increase the use of telemedicine in Medication Assisted Treatment (MAT) therapy, a key component of substance abuse disorder treatment.

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By Eric Wicklund

- Congress is considering legislation that would remove a significant barrier to the use of telemedicine in opioid abuse treatment.

Senators Maggie Hassan (D-NH) and Lisa Murkowski (R-AK) this week introduced the Mainstreaming Addiction Treatment (MAT) Act, which aims to remove waiver requirements for Medication Assisted Treatment (MAT) therapy and enable providers to use connected health platforms to prescribe drugs and monitor medication adherence.

The bill mirrors one introduced this past May in the House by Reps. Paul Tonko (D-NY), Antonio Delgado (D-NY), Ben Ray Lujan (D-NM), Ted Budd (R-NC), Elise Stefanik (R-NY) and Michael Turner (R-OH).

Both bills target a long-standing challenge to the expansion of MAT programs: the requirement that providers apply for a waiver from the US Drug Enforcement Agency (DEA) to prescribe buprenorphine for substance abuse disorder (SUD) treatment.

The process includes eight hours of training and approval from the Substance Abuse and Mental Health Services Administration (SAMHSA), which gives the clinician a code that must be used to prescribe buprenorphine. The waiver allows clinicians to prescribe medication for as many as 30 patients during the first year, with the ability to apply to expand that number to 100 after the first year and up to a maximum of 275.

That process scares away many providers who don’t have the time or resources to apply for the waiver, as well as those living in rural areas. As a result, many providers with waivers live in urban areas and focus on in-person treatment.

Legislators say they want to expand opportunities for providers to treat patients, both by making it easier to prescribe medications and use virtual care platforms.

“If healthcare professionals are able to prescribe opioids to patients, then they should able to prescribe medications that help manage opioid dependence as well,” Murkowski said in a press release. “By removing barriers to life-saving medication-assisted treatments that have been clinically proven to help patients safely reduce or even end their dependence on opioids, we can ensure Americans struggling with substance abuse have access to the treatment they need to fully recover.” 

Murkowski reportedly lobbied to include a provision in the bill that would amend the Controlled Substances Act “to allow patients being treated by community health aides or community health practitioners to dispense a narcotic drug in schedule III, IV, or V, such as buprenorphine, or a combination of such drugs, to an individual for medication-assisted treatment if the drug is prescribed by a practitioner through telemedicine.”

That clause is particularly helpful in rural states like Alaska, where those dealing with substance abuse and their care providers often face access issues tied to geography and weather.

“By allowing community health aides and practitioners to dispense needed medications locally, this bill will eliminate the significant travel burden that many Alaskans fighting addiction in rural communities currently face,” Andy Teuber, Chairman and President of the Alaska Native Tribal Health Consortium, said in the press release.

The waiver requirement was put in place in 2008 with passage of the Ryan Haight Act, which prohibits physicians from prescribing controlled substances electronically until they have conducted an in-person examination, or if they meet the federal definition of practicing telemedicine.  The definition requires that the patient be treated by, and physically located in, a hospital or clinic which has a valid DEA registration and the telemedicine practitioner is treating the patient in the usual course of professional practice.

While there are exceptions made for telemedicine, the language is murky. Since 2015, telemedicine advocates have lobbied the DEA to create a special registration process to prescriptions of controlled substances through telemedicine without need for an in-person exam. While the DEA has signaled in interest in agreeing to the caveat, it hasn’t yet.

Healthcare providers are also increasingly using telemedicine – including Project ECHO programs – to extend the reach of providers who have a DEA waiver to both treat patients and help clinics and practices in rural and remote parts of the country.

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