Assessment of State and Federal Health Policies for Opioid Use Disorder Treatment During the COVID-19 Pandemic and Beyond

Abstract

Importance: Federal and state governments implemented temporary strategies for providing access to opioid use disorder (OUD) treatment during the COVID-19 pandemic. Advocates hope many of these policies become permanent because of their potential to expand access to care.

Objective: To consider the multitude of ways access to and utilization of treatment for individuals with OUD might have been expanded by state and federal policy so researchers can do a better job evaluating the effectiveness of specific policy approaches, which will depend on the interaction with other state policies.

Evidence review: We summarize state-level policy data reported by government and nonprofit agencies that track health care regulations, specifically the Kaiser Family Foundation, Federation of State Medical Boards, American Association of Nurse Practitioners, American Academy of Physician Assistants, and the National Safety Council. Data were collected by these sources from September 2020 through January 2021. We examine heterogeneity in policy elements adopted across states during the COVID-19 pandemic in 4 key areas: telehealth, privacy, licensing, and medication for opioid use disorder. The analysis was conducted from March 2020 through January 2021.

Findings: This cross-sectional study found that federal and state governments have taken important steps to ensure OUD treatment availability during the COVID-19 pandemic, but few states are comprehensive in their approach. Although all states and Washington, DC have adopted at least 1 telehealth policy, only 17 states have adopted telehealth policies that improve access to OUD treatment for new patients. Furthermore, only 9 states relaxed privacy laws, which influence the ability to use particular technology for telehealth visits. Similarly, all states have adopted at least 1 policy related to health care professional licensing permissions, but only 35 expanded the scope of practice laws for both physician assistants and nurse practitioners. Forty-four states expanded access to initiation and delivery of medication for OUD treatment. Together, no state has implemented all of these policies to comprehensively expand access to OUD treatment during the COVID-19 pandemic.

Conclusions and relevance: With considerable policy changes potentially affecting access to treatment and treatment retention for patients with OUD during the pandemic, evaluations must account for the variation in state approaches in related policy areas because the interactions between policies may limit the potential effectiveness of any single policy approach.

Figure 1.

State Licensing Requirements and Scope of Practice Policies During the COVID-19 Pandemic

Figure 2.

State Implementation of Federal Policies Related to Medication for Opioid Use Disorder During COVID-19 DEA Indicates US Drug Enforcement Administration; OTP, opioid treatment program; SAMHSA, Substance Abuse and Mental Health Services Administration.

Figure 3.

State Policies Influencing Opioid Use Disorder Treatment During the COVID-19 Pandemic DEA Indicates US Drug Enforcement Administration; OTP, opioid treatment program; SAMHSA, Substance Abuse and Mental Health Services Administration. States in the outermost layer under the title “behavioral health facilitated via telehealth” include those that enacted all 3 of the following policies: telehealth coverage for behavioral health, waiver of requirement for established clinician-patient relationship for telehealth, and waiver of requirement for prior in-person contact for telehealth.