Last Updated: Sep 15, 2020
Due to the COVID-19 emergency, the Pa. Department of State (DOS) has announced a new regulatory waiver allowing buprenorphine treatment via telemedicine for opioid use disorder.
Before a patient can be admitted to an opioid treatment program and treated with buprenorphine, federal law requires the patient to first undergo a complete, in-person physical evaluation. Many in-person interactions, including medical examinations, have been curtailed due to the COVID-19 emergency.
To address this issue and allow states to expand the use of telemedicine to treat opioid use disorder, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) issued an announcement exempting opioid treatment programs from the in-person physical examination requirement for patients who will be treated with buprenorphine. This exemption requires a determination by a program physician, primary care physician or authorized healthcare professional under the supervision of a program physician that an adequate evaluation of the patient can be accomplished via telemedicine.
In Pennsylvania, State Board of Medicine regulations, see 49 Pa. Code §16.92(b)(1), require that practitioners regulated by the Board take an initial medical history and conduct an initial physical examination of a patient, unless emergency circumstances justify otherwise, before prescribing any controlled substances. Given the current circumstances, this requirement curtails access to buprenorphine provided via telemedicine.
To address this issue, DOS has requested and received approval from the Governor’s Office to suspend the initial medical history and physical examination requirement for the duration of the COVID-19 disaster declaration.
Note that this waiver is specifically limited to the treatment of opioid use disorder with the FDA-approved, office-based treatment medication buprenorphine. A person licensed to practice medicine and surgery must comply with the standards of acceptable and prevailing medical practice. Methadone treatment models that are restricted to DEA-approved opioid treatment programs are not covered by this waiver.
View the full text of the waiver here.
Earlier in the COVID-19 emergency, the Pennsylvania Department of Drug and Alcohol Programs (DDAP) suspended the requirement that licensed Narcotic Treatment Programs (NTPs) make a face-to-face determination before admission to treatment for clients who receive buprenorphine treatment. DDAP also suspended the requirement that NTPs have narcotic treatment physician services onsite. These regulatory suspensions by DDAP will remain in effect for the duration of the COVID-19 disaster emergency in Pennsylvania.
Where Can I Find Additional Information?
Due to the COVID-19 emergency, additional statutory and regulatory suspensions are expected to be forth coming, the Pennsylvania Medical Society (PAMED) will continue to provide updates as these suspensions are announced. When announced, licensing suspensions will be posted by on the DOS website here
PAMED has established a COVID-19 resource page where you will find additional information and resources on the COVID-19 outbreak.