APA’s Government, Policy, and Advocacy Update (March 2024)

On February 2, the Substance Abuse and Mental Health Services Administration issued a final rule that permanently allows patients to begin treatment with buprenorphine via telehealth. The rule also allows for increased flexibility related to methadone take-home doses, reducing the number of times patients must visit clinics. These are both provisions for which APA had advocated to be included in the final rule, arguing that they would improve access to care while reducing stigma and disruptions to patients’ daily lives.

The rule goes into effect on April 2, with a compliance deadline of October 2. The rule marks the first time in 20 years that the Department of Health and Human Services (HHS) has substantially updated its opioid treatment program (OTP) regulations. “This final rule represents a historic modernization of OTP regulations to help connect more Americans with effective treatment for opioid use disorders,” Miriam E. Delphin-Rittmon, Ph.D., the HHS assistant secretary for mental health and substance use, said in a news release.

The rule makes permanent some of the temporary flexibilities that the federal government put in place during the COVID-19 Public Health Emergency. It allows patients to access methadone treatment via audiovisual technology and buprenorphine treatment via audiovisual or audio-only technology. It also allows patients up to seven days of take-home methadone doses during the first two weeks of treatment, up to 14 days of take-home doses starting on day 15 of treatment, and up to 28 days of take-home doses starting on day 31. Previously, patients were initially required to visit clinics daily to get their methadone doses.

The new rule also expands access to interim treatment (allowing patients to begin medication treatment while waiting for more comprehensive services), thus reducing waitlist barriers. Additionally, the rule removes the requirement that patients must have a history of opioid use disorder for one full year before becoming eligible for treatment. This regulatory change, for which APA also advocated, helps prevent further harm caused by requiring patients to wait before they can access effective treatment.

Finally, another major update ensures that medication continuity is not contingent upon involvement in counseling services, allowing practitioners and patients to tailor treatment collaboratively.

The Centers for Medicare and Medicaid Services approved decreasing physician payments by 3.4% for 2024. In response, APA has issued a call to action, urging members to contact their representatives and ask that they co-sponsor legislation to offset the cut.

“This cut is devastating to physician practices and the patients they care for and could necessitate reduced staffing and office closures, disproportionately harming rural and underserved communities,” APA’s action alert stated.

The bipartisan Preserving Seniors’ Access to Physicians Act (HR 6683) would completely eliminate the 3.4% payment cut. It is co-sponsored by Reps. Gregory Murphy (R-N.C.), Danny Davis (D-Ill.), Brad Wenstrup (R-Ohio), Larry Bucshon (R-Ind.), Michael Burgess (R-Tex.), and Jimmy Panetta (D-Calif.).

APA and other health organizations sent a letter to Senate leaders to urge them to continue allowing the National Institute on Drug Abuse (NIDA) to fund research related to harm reduction regarding substance use. The organizations raised their concerns over language in the House’s Fiscal 2024 Labor, Health and Human Services, Education and Related Agencies Appropriations bill, which would prohibit NIDA from funding such research.

Harm reduction strategies are distinct from treatment or recovery support. They include efforts to prevent overdose deaths among people actively using drugs, prevent the transmission of infectious diseases due to drug use, and prevent other harms associated with drug use. “Decades of research support individual and public health benefits of harm reduction services,” the letter stated. “NIDA currently supports research on how to best implement proven harm reduction strategies and to explore the effectiveness of new and emerging approaches, particularly in resource-challenged settings.”

The letter was addressed to Sens. Tammy Baldwin (D-Wis.) and Shelley Moore Capito (R-W.Va.), chair and ranking member, respectively, of the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.

“Harm reduction is a critical part of our national strategy to address the addiction and overdose crises,” the organizations wrote. ■