Before the COVID-19 pandemic, federal law required most people taking methadone for opioid use disorder (OUD) to visit an opioid treatment program (OTP) daily or near daily to receive a single dose of medication. In March 2020, however, in response to pandemic-related social distancing guidelines and stay-at-home orders, the federal government permitted states to make OUD treatment more flexible. If state regulators allowed it, OTPs could give patients up to 28 days’ worth of methadone for use at home and provide them with services such as counseling via telehealth.
To understand how states adjusted OUD treatment during the pandemic and how they plan to provide care in the future, The Pew Charitable Trusts contacted OTP authorities nationwide; officials representing 37 states responded to at least one question. And the results highlight the critical importance of federal action to ensure that new flexibilities can continue once the pandemic has receded. The data shows that:
At least 34 states received a blanket waiver from the federal government to allow OTPs to provide extended take-home methadone. Officials indicated that, on average, 95% of OTPs in their state adopted this policy.
When Pew contacted state officials in the summer of 2021, of the 34 states that allowed take-home methadone during the pandemic (See Figure 1):
Medicaid is the nation’s largest insurer for behavioral health services. That means the program’s coverage of treatment services delivered by telehealth dramatically increases patient access to OUD treatment. At least 23 state Medicaid programs changed payment policies to cover OUD treatment services delivered by telehealth since the start of the pandemic in 2020.
Similarly, many public insurance programs plan to continue to cover OUD treatment services delivered by telehealth.
As of summer 2021, of the 23 Medicaid agencies that changed their coverage policies to include telehealth, 12 planned to continue covering these services for the duration of the public health emergency and 11 planned to make this change permanent. (See Figure 2a.)
Of the 22 Medicaid agencies that allowed providers to bill for telehealth-provided services at parity with in-person services, 13 said last year that they plan to continue allowing this for the duration of the public health emergency. Nine said they planned to make this change permanent. (See Figure 2b.)
Over the course of the pandemic, patients have been highly satisfied with these treatment flexibilities, and the data shows an absence of negative treatment outcomes. So will federal and state agencies continue to allow people with OUD to receive extended take-homes and telehealth services?
They can and should. Effective treatment is out of reach for many Americans struggling with OUD, in part because federal policies make it difficult for people to receive FDA-approved medications. The COVID-19 pandemic demonstrated that current restrictive policies are not necessary. Take-home methadone and telehealth-based OUD services have proved just as effective as in-person care, and their availability has enabled more people to access treatment. As a result, policymakers and program leaders in many states want to preserve these flexibilities after the public health emergency ends. It was last renewed on April 16.
The Substance Abuse and Mental Health Services Administration has temporarily extended take-home rules for one year after the emergency ends, but more must be done. It’s time for the federal government to act and make extended take-home methadone dosing and telehealth-based OUD services a permanent treatment option.
Vanessa Baaklini is a senior associate, Frances McGaffey is an associate manager, and Sheri Doyle is a senior manager, all with The Pew Charitable Trusts’ substance use prevention and treatment initiative.