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Health officials want permanent pandemic flexibility as overdoses climb


(The Center Square) – Researchers say they recently discovered a grim consequence of the pandemic: overdose death rates climbed dramatically.

The United States saw overdose fatalities increase 50%, with 107,000 people dying in 2021. The biggest spikes happened among American Indian and Native Americans and black Americans. Among adolescents, overdoses more than doubled.

Federal regulatory changes during the pandemic, however, granted more flexibility that some health professionals and advocates want to keep in place permanently.

“There are three main things that have changed a great deal at the federal level: allowance for telehealth, provider regulation with the (Drug Enforcement Administration) and removal of the X-Waiver, and the ability for (opioid treatment programs) to allow take-home doses,” Zoe Barnard, senior adviser of Manatt Health, said during an event hosted by the Foundation for Opioid Response Efforts that explored how opioid addiction treatment has been affected by the pandemic.

The X-Waiver refers to a DEA requirement that allows providers to prescribe buprenorphine, a drug used to treat opioid use disorder. Granting doctors the ability to permit take-home doses for a number of different anti-opioid drugs changed during the pandemic.

Telehealth expansion, for example, allowed them to prescribe medication for opioid use disorder (MOUD) after a phone or video call. Promising results followed that change.

“The incorporation of telehealth technology with MOUD is associated with patients being happier, staying in treatment, reducing health care costs, increasing usage of medication, and increasing engagement with patients,” Barnard said.

One study found that telehealth can reduce the risk of drug overdoses, as The Center Square previously reported. A six-month rule extension announced in early May will also preserve a COVID-era rule that allows doctors to prescribe controlled medications without an in-person evaluation.

Other rule changes during the public health emergency pleased patients.

Methadone patients could also take home medication, rather than needing to take it on-site – a change which Barnard argued did not increase harmful outcomes and gave those with an opioid use disorder “the flexibility to better meet the demands of work and family.”

“Patients, especially those living in rural communities or long distances from an (opioid treatment program), vastly preferred take-home doses and it really eliminated access barriers,” Barnard said.

Federal officials, too, said preserving some temporary reforms that relaxed regulations offered immense opportunities.

“In his State of the Union address, the president made it very clear that he wanted to reduce the barriers to treatment, especially those that were regulatory,” said Beth Connolly, assistant director of the Office of Public Health in the Office of National Drug Control Policy. “In terms of harm reduction, we’re looking at increasing access to low-barrier treatment.”

Connolly also noted the importance of increasing the use of fentanyl test strips – which government entities and non-profit groups can pay for with federal money – and expanding access to the anti-overdose drug naloxone.

The greatest jolt that expanded access during the pandemic, one physician said, may have come from telehealth growth.

“Telehealth was a complete game changer for the people working in the safety net,” said Andrew Herring, founder and director of the addiction treatment provider California Bridge and chief of addiction medicine in the Alameda Health System. “We just need common-sense enabling of providers to use telehealth to reach people efficiently.”

The Foundation for Opioid Response Efforts has given grants to Herring and dozens of other groups to reduce overdoses and expand medication access. Four grants were made in Pennsylvania – to the University of Pittsburgh, Thomas Jefferson University, Temple University, and the Allegheny Health Network.

Though the federal public health emergency has expired, Pennsylvania’s state government will still have some services in place for COVID-19, along with opioid use disorder.

“Pennsylvanians should know that despite the end of the PHE, the Shapiro Administration remains committed to their health and safety,” Mark O’Neill, press secretary for the Department of Health, said. “The pandemic has highlighted areas of concern as it relates to behavioral health, substance use, and specialty care access in rural Pennsylvania and other underserved communities.”

COVID-19 vaccines are still available, as are treatments, he noted, and pointed out funding for public health initiatives.

Governor Shapiro’s 2023-2024 budget provides, among other things, for dedicated funding for mental health services for Pennsylvanians, including for the 988 emergency hotline and $200,000 for farmer mental health supports,” O’Neill said. “To combat these issues and more, the department will continue to collaborate with other state agencies and partners across the health care spectrum to fill in any gaps that may arise.”

Drug recovery hubs have also received grants in recent months from the Shapiro administration, and the commonwealth’s opioid settlement fund has also provided funds for addiction treatment statewide.

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