SAMHSA proposes permanent changes to OUD treatment, hoping to expand access

The Substance Abuse and Mental Health Services Administration is proposing permanent changes to federal rules that would allow take-home doses of methadone and greater use of telehealth, according to a press release.

SAMHSA, which is part of HHS, initially proposed those changes on a temporary basis during the pandemic to ensure that patients continued to have uninterrupted access to opioid use disorder (OUD) treatment.

The move comes amid a historic rise in the number of overdose deaths in the United States, especially in underrepresented populations.

“These proposed updates would address longstanding barriers treatment in regulations — most of which have not been revised in more than 20 years,” Miriam E. Delphin-Rittmon, PhD, the HHS assistant secretary for mental health and substance use and head of SAMHSA, said in the release. “I am committed to moving these forward as quickly as possible because we have heard from both providers and patients how urgent the need is for treatment.”

A recent survey showed that physicians were overwhelmingly in favor of making telehealth a permanent part OUD treatment in their practices.

Early in the pandemic, SAMHSA made it possible so that patients could initiate buprenorphine in opioid treatment programs (OTP) and take home methadone in certain quantities. Those deemed “stable” by their physicians have been allowed to take home nearly a month’s worth of methadone, and others were able to receive a 2-week supply.

According to SAMHSA, these represented the first substantial changes to OTP standards in more than 2 decades, resulting in “positive impacts on [patients’] recovery, including being more likely to remain in treatment and less likely to use illicit opioids.”

“Removing these barriers promotes patient trust and reduces the need for individuals to attend an OTP each day to receive treatment services,” Delphin-Rittmon said in the release.

The updates that SAMHSA is proposing would reflect “language that aligns with current medical terminology,” evidence-based practice, the workforce providing services in OTPs and effective patient engagement approaches, including:

• updating take-home doses of methadone criteria;
• adding “evidence-based delivery models of care” like telehealth, harm-reduction activities and split dosing;
• removing outdated terms like “detoxification”;
• strengthening the relationship between patient and practitioner through shared decision-making;
• redefining an OTP treatment practitioner to include “any provider who is appropriately licensed to dispense and/or prescribe approved medications”; and
• reviewing the accreditation standards for OTPs.

Public comment on the proposed changes is open until Feb. 14.

References:

• Beetham T, et al. Am J Manag Care. 2022;doi:10.37765/ajmc.2022.89221.
• SAMHSA proposes update to federal rules to expand access to opioid use disorder treatment and help close gap in care. https://www.samhsa.gov/newsroom/press-announcements/20221213/update-federal-rules-expand-access-opioid-use-disorder-treatment. Published Dec. 13, 2022. Accessed Dec. 13, 2022.