Congress is getting annoyed with the stalling by the Drug Enforcement Administration (DEA) on mobile vans and telemedicine for treatment for opioid use disorder (OUD).
A letter sent in January by Sen. Patty Murray (D-WA), Sen. Elizabeth Warren (D-MA), and Congresswoman Annie Kuster (D-NH), to Uttam Dhillon, acting administrator of the DEA, called out the DEA for failing to increase actions in the face of the continuing opioid epidemic.
“We write today to urge the Drug Enforcement Administration (DEA) to take all available actions to address the opioid crisis, including expediting two key regulations concerning addiction treatment: first, authorizing special registration for health care providers to provide medication-assisted treatment (MAT) via telemedicine, and second, issue DEA regulations related to improving access to MAT through the use of mobile clinics,” the legislators wrote. “Both regulations have remained on the DEA’s unified agenda for nearly two years, with no rule promulgated for either. We ask that the regulatory process move forward quickly, since both provisions will help those on the frontlines better respond to the pressing opioid crisis.”
Congress set the deadline for these steps two years ago.
The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, enacted on October 24, 2018, includes a provision requiring the DEA to issue a rule within a year of enactment that would make it easier for health care providers to use MAT to treat patients.
Under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, the DEA can authorize “special registrations” that allow providers to prescribe controlled substances online without an in-person medical evaluation. However, the DEA has never implemented this authority.
In 2015, the DEA said it would start the rulemaking process allowing for telemedicine inductions of buprenorphine, but this has not happened. The statutory deadline passed last October, and there is still no proposed rule from the DEA.
Likewise, the DEA has been dragging its feet in approving mobile methadone clinics.
“We also urge the DEA to issue their expected regulations that would expand access to MAT through the use of mobile methadone clinics,” the lawmakers write. For almost 30 years mobile clinics to treat OUD have been useful in rural areas and underserved inner city areas, they add. In fact, methadone assisted treatment, one of the most effective methods of MAT available, is inaccessible for many patients, as it is only prescribed in 1,500 locations around the country,” the lawmakers write to the DEA. “Mobile methadone clinics have the potential to make MAT more accessible to patients, and we urge the DEA to issue their expected regulations as promptly as possible.”