Reimagining Law and Policy Affecting Individuals with Substance Use Disorders Post-Final Rule

Abstract: On January 17, 2025, the federal government released three new regulations that restrict the ability of an otherwise authorized prescriber to use telemedicine to induct and to subsequently prescribe buprenorphine, a schedule III controlled substance approved by the Food and Drug Administration for the treatment of opioid use disorder (OUD). One of these new regulations: (1) limits the tele-induction and subsequent tele-prescription of buprenorphine for treatment of OUD to a six-month period; then, an in-person medical evaluation or satisfaction of another exception to the in-person medical evaluation must occur; and (2) requires the prescribing practitioner to access and review data in the prescription drug monitoring program (PDMP) of the state in which the patient is located at the time of the encounter. Panelists representing the disciplinary perspectives of law, bioethics, nursing, health humanities, and public health will challenge these new regulations, arguing that they could interfere with access to care, retention in treatment, and health outcomes. The first panelist will use the current, evidence-based literature to challenge the safety, efficacy, and diversion concerns that were offered by the government in defense of its new regulation. The second and third panelists will discuss the validation and efficacy issues that pertain to PDMPs and explain how clinical overreliance and misuse of PDMP algorithms by OUD healthcare facilities and providers implicates federal disability anti-discrimination laws. The fourth panelist will situate the conversation more broadly in terms of the social determinants of behavioral health and the risks of relying on “aggregate” metrics of success.

Keywords: substance use disorder, telemedicine, non-discrimination laws