The White House declared this week Overdose Awareness Week, boasting $22 billion of new investment to address the overdose crisis — including massive investments in “expanding access to life-saving medications.”
At the same time, POLITICO reported that the Drug Enforcement Administration (DEA) proposed new rules that would restrict telehealth care that hundreds of thousands of patients overcoming opioid addiction rely on every day.
While not published, these draft rules were sent to the White House and the Dept. of Health and Human Services, and, per the reporting, both balked at the DEA’s overly-restrictive and burdensome proposal.
U.S. Sen. Mark Warner described the DEA’s proposal as “arcane” and a “major step back,” releasing the statement, "We don’t need an arbitrary new set of regulations. We just need DEA to set up the minimum training requirements for providers and a special registration that allows the DEA to do its job...”
Industry advocates are mobilizing to action, asking, why is the federal government threatening one of the most proven and cost-effective tools for treating opioid use disorder (OUD)? We believe American communities devastated by fentanyl, overdose, and addiction deserve better.
This is hardly the first time our government has placed stringent restrictions on essential medications. But after decades of misguided policies — and with illicit fentanyl making opioid addiction deadlier than ever before in history — we can’t afford to repeat past mistakes.
In light of the news, we wanted to share where we are, how we got here, and discuss our vision for the future: a future where overdose deaths are rare, addiction medicine is compassionate, evidence-based, and widely accessible, and patients have a permanent right to remote care when they need it. We believe technology plays a vital role in making this future a reality. This is why Boulder exists, and it’s why we’re not going anywhere.
Pandemic Telehealth Policies Ushered In A New Reality
At the onset of the COVID pandemic, Boulder and several other telehealth practitioners stepped into the breach when the government declared a public health emergency: easing restrictions on providers’ ability to practice medicine remotely. This created a new reality overnight.
By lifting restrictions on controlled medicines like Suboxone, the new landscape illuminated a path to reach people who, for a slew of complex structural and personal reasons, were not being served by traditional brick-and-mortar medicine.
Providers could start prescribing medication for addiction treatment (MAT) remotely, at the urgent moment people reached out for help, in the urgent moments before withdrawal, anxiety, or other external barriers got in the way. Instead of being met with long waitlists at overwhelmed, underfunded clinics, patients seeking addiction care could be seen within minutes.
Proven, Safe, and Effective
When we started Boulder in 2017, prior to COVID19, a handful of us believed in the immense potential of telehealth. But we were often met with skepticism. Over the last four years, this has dramatically changed. In fact, some of the biggest skeptics have become the loudest evangelists.
As patients and practitioners continue to realize myriad benefits of telehealth, researchers have studied outcomes of virtual services across all 50 states. The new reality has produced unassailable success on most every measure.
A 2023 study examined telehealth services for OUD among Medicare beneficiaries, finding that patients who received telehealth had a 33% lower risk of a fatal overdose. Similar positive findings have been replicated in other studies, showing improved retention in care and reduced mortality.
Every major medical association and elected officials from both parties support scaling up telemedicine, and believe it to be an urgent national priority.
The outcomes and support for telemedicine are born out of its unique ability to reach people who were previously unreachable: including those who live far away from services, lack a driver’s license, have disabilities, or who have difficulty showing up for in-person appointments without risking their job, social standing, or safety for themselves or their children.
Easing restrictions on in-person visits has expanded care for hard-to-reach populations in profound ways. At Boulder, we’ve seen unprecedented retention in care, reduced hospitalizations, emergency visits, and overdoses, and more equitable access for patients with complex needs. We celebrate success with thousands of personal stories from people who are getting better and healthier everyday.
Closing the Gap
As the founder of Boulder with a background in health policy, I deeply appreciate the importance of regulatory guardrails in shaping our industry. I’ve worked in the addiction field for ten years, where I’ve seen firsthand how policy trends impact outcomes. — for better and for worse.
Anyone who has navigated this treatment landscape for some time would likely agree: it’s disappointing that our government continues to take two steps forward, and one step back. But it’s not surprising.
Access to MAT in America has a long and tangled history. For most of the last two decades, medications like methadone and buprenorphine were among the most heavily regulated and restricted on the market.
Until a little over one year ago, a licensed provider could only prescribe buprenorphine after receiving a special X-DEA waiver. Even then, they could initially treat a maximum of 30 patients. Methadone remains even more inaccessible, tightly controlled in a “closed system” that limits the drug's availability.
Finally, in 2023, the federal government slashed these restrictions: citing the paramount importance of expanding access to medication (the single most effective treatment for OUD).
But it was too little too late. Prescribing levels have remained stubbornly flat.
Of the millions of Americans with OUD, the vast majority do not receive life-saving medications.
Telehealth offers hope where other costly, sweeping interventions have failed, promising to swiftly close the massive gap in treatment supply and demand — if we let it.
The Path Forward
The data are crystal clear: We need to keep our foot on the gas and dramatically ramp up care.
In a recent speech, DEA Administrator Anne Milgrim said that fentanyl poses the single greatest threat to America. Not just the greatest drug threat, but the greatest threat. On this, we happen to agree. And that’s why we can’t fathom a return to the old reality where people struggle to navigate high barrier systems just to access the care they want and need.
Boulder was created seven years ago to break down those barriers and address an overdose crisis that was spiraling out of control. This catastrophe was decades in the making — in no small part due to failed federal policy — and it’s not going to reverse itself overnight.
But the past four years of unprecedented access to telemedicine showed us what’s possible. It’s going to take all of us working together to flatten the overdose curve. We must protect and expand access to medicine that gives people their lives back.
If the DEA cannot cement permanent access to telehealth care — in what is now their second attempt, after recalling unpopular proposed rules last year – will Congress step in? Will the President, fulfilling his inaugural promise to expand addiction treatment? Regulatory uncertainty continues, but one tenant is certain: whatever boulders we must move on the path ahead, we will never stop advocating for the patients, families, and communities relying on us.
