Restricting telehealth prescriptions for opioid use disorder could undermine recovery

Weill Cornell Medicine researchers found that restricting telehealth prescriptions for opioid use disorder could keep thousands from accessing buprenorphine, a medication that helps people recover from addiction. The study, published March 3 in JAMA Network Open, warns that requiring in-person visits—as had been proposed by the Drug Enforcement Agency (DEA)—may undo the progress made during the COVID-19 pandemic when telehealth increased access to this life-saving treatment. Previous studies show telehealth buprenorphine prescriptions improve treatment use and reduce overdose rates.

Before the pandemic, federal law required doctors to examine patients in person before prescribing controlled substances. This rule was suspended temporarily in March 2020, allowing doctors to prescribe buprenorphine through online telehealth visits, which made receiving treatment for opioid use disorders easier, especially for those in rural areas or without reliable transportation.

If this in-person rule had been in place from 2020 to 2022, 4,500 patients in the large national sample we studied would have missed getting treatment."

Dr. Beth McGinty, first author and Livingston Farrand Professor of Population Health Sciences at Weill Cornell Medicine

The study was co-led with Dr. Matthew Eisenberg, associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

For many battling opioid addiction, telehealth is a lifeline that can lead to recovery, said Dr. McGinty. The study's findings could guide policymakers in developing evidence-based telehealth regulations that ensure safe and responsible prescribing.

The researchers analyzed approximately 229,000 first-time buprenorphine prescriptions issued in the United States between 2020 and 2022, with nearly 10% of these initiated via telehealth. Among those, about 28% of patients had not seen their prescribing doctor in the previous two years, and 20% had neither a prior visit two years before starting treatment nor a follow-up in-person visit within 30 days.

The researchers noted that patients on Medicare (28%) and private insurance (26%) were more likely to start treatment without an in-person visit than those on Medicaid (16%). Additionally, behavioral health doctors and nurse practitioners—who often serve communities with high risk of opioid addiction and overdose—were more likely to prescribe buprenorphine without an in-person visit than primary care doctors.

Though the DEA ruled in January 2025 that registered practitioners could prescribe buprenorphine via telemedicine for an initial six-month supply, implementation is on hold pending review by the current administration.

"Allowing telehealth treatment initiation and continued prescribing for six months before requiring an in-person visit helps address concerns that restrictions could impede access to life-saving buprenorphine due to limited in-person appointment availability or transportation barriers," Dr. McGinty said. "As the debate over telehealth policies continues, this study underscores the importance of preventing unnecessary barriers for those seeking recovery."