Thursday, April 6, 2023

Mental health is public health. Recent research from Princeton economists Anne Case and Angus Deaton reported that the fastest-rising death rates among Americans were from drug overdoses, suicide, and alcoholic liver disease — these are deaths of despair. 

In our work seeking to track and understand the laws and policies related to drug use and substance use disorder at CPHLR, we’ve uncovered a patchwork of laws and policies in the United States for people in recovery, made more complex by the COVID-19 pandemic. is home to six datasets that capture laws and policies related to Medication for Opioid Use Disorder (MOUD).  

Early during the pandemic, the US Drug Enforcement Agency relaxed certain telehealth provisions, including allowing controlled substances to be prescribed via telehealth without the need for an initial in-person visit. Through early guidance documents, state agencies managing substance use disorder treatment encouraged measures that built upon this federal baseline, urging further relaxation in telehealth requirements, a removal of prior authorization requirements, an extension of prescription lengths for take-home doses, and naloxone co-prescribing.   

Ultimately, very few states have taken MOUD-specific action during COVID-19:  

  • Just six states have removed the requirement for an in-person visit between a patient and a provider before starting MOUD treatment with buprenorphine.
  • Iowa and New York are the only states to have permanently removed prior authorization requirements for Medicaid for MOUD treatment during COVID-19.
  • Four states have extended the dosage for take-home MOUD prescriptions during COVID-19: Pennsylvania for buprenorphine, and Connecticut, Hawaii, and Pennsylvania for methadone.  

Individuals with opioid use disorder who are involved in the criminal justice system face unique barriers to treatment and care. We developed a dataset that examines whether state correctional facilities have explicitly established a medication for opioid use disorder (MOUD) treatment program, and whether and how states ensured continued access to MOUD treatment during the pandemic, and that captures state variance among different COVID-19 mitigation measures related to correctional facilities, like early release and visitation restrictions.   

Few state correctional facilities had established MOUD treatment policies prior to COVID-19, and even fewer have made changes to adapt to the need for continued treatment upon release, especially as states institute early release orders for some populations. 

As deaths from drug overdose continue to peak at more than 100,000 people annually, access to care and support is essential.