The coronavirus pandemic has reshaped nearly every part of the healthcare system, including how medication-assisted treatment (MAT) for substance use disorder (SUD) is delivered. While COVID-19 has posed immense challenges, it also created an unexpected opportunity to modernize access to MAT. Regulatory flexibilities introduced during the public health emergency have reduced barriers for patients, making it easier to start and maintain treatment.
Now, providers and advocates are pushing for those changes to remain in place long after the pandemic subsides. They argue that the success seen in telehealth prescribing, remote therapy sessions, and insurance coverage expansions highlights the need for permanent reforms.
How COVID-19 Changed Access to MAT
Before the pandemic, federal rules like the Ryan Haight Online Pharmacy Consumer Protection Act required new MAT patients to be evaluated in person before receiving certain prescriptions. For patients seeking buprenorphine, a widely used MAT medication, this often meant arranging transportation, taking time off work, and facing potential stigma by visiting a clinic.
COVID-19 forced regulators to act quickly to remove barriers. The Substance Abuse and Mental Health Services Administration (SAMHSA) granted emergency flexibilities that allowed clinicians to prescribe buprenorphine to new patients via telehealth if they could be adequately evaluated virtually. This marked a significant shift, bringing long-awaited relief for providers and patients alike.
Daniel Watkins, director of outpatient services at Pathways in Annapolis, Maryland, saw firsthand how the flexibility improved patient engagement. Pathways, part of Anne Arundel Medical Center, serves between 15 to 25 outpatient MAT patients each month, many of whom are Medicaid beneficiaries. According to Watkins, removing the in-person requirement boosted attendance and lowered barriers, creating a more equitable system for people in recovery.
Buprenorphine Flexibility: A Game-Changer
Buprenorphine has been one of the biggest beneficiaries of COVID-19-related changes. Previously, strict regulations limited who could prescribe the drug, how many patients they could serve, and required additional training for providers. By allowing tele-prescriptions, new patients can now start treatment without logistical hurdles.
This added privacy and accessibility has been life-changing. For many patients, telehealth removes the need to explain absences from work, arrange childcare, or travel long distances to appointments. Watkins emphasized that these changes help level the playing field, making it easier for patients across different socioeconomic backgrounds to access treatment.
At Intermountain Healthcare in Utah, similar benefits have emerged. The health system had been working on a tele-MAT program for over a year but faced barriers due to federal rules. COVID-19 opened the door, allowing Intermountain to scale its efforts. Leaders at the organization hope these changes will remain, giving providers more tools to serve patients efficiently.
Insurance Coverage and Virtual Care
Another major shift came in the form of insurance coverage. Historically, insurers required in-person attendance for group intensive outpatient programs (IOPs), refusing to reimburse for virtual participation. The pandemic forced payers to adapt, recognizing telehealth IOPs as valid and reimbursable.
This change alone has increased participation at Pathways by 10%. According to Watkins, patients are now more likely to remain engaged in treatment because virtual options reduce common obstacles. Previously, a patient might stop attending sessions after just a few weeks due to transportation issues or scheduling conflicts. Now, remote access allows patients to stay connected and supported, increasing the effectiveness of both counseling and medication.
Ongoing Challenges and Limitations
While the pandemic has opened doors, challenges remain. Remote monitoring tools like urine drug screenings are more difficult to conduct virtually, raising concerns about accountability and clinical oversight.
Additionally, not all MAT medications have benefited equally. Methadone, another commonly prescribed MAT drug, has stricter regulations due to its higher risk of overdose. Unlike buprenorphine, methadone cannot be prescribed to new patients via telehealth. Patients must still visit licensed facilities in person, often multiple times per week, creating significant barriers for those with limited resources.
Joe Pritchard, CEO of Pinnacle Treatment Centers, which operates 115 facilities across eight states, expressed frustration at the lack of flexibility for methadone. Since many methadone patients rely on Medicaid and face socioeconomic challenges, requiring in-person visits only adds to the difficulty of maintaining treatment. Providers like Pinnacle are pushing for balanced reforms that expand access while maintaining safety standards.
The Case for Permanent Change
For MAT providers, the pandemic has underscored a long-standing inequity in how addiction treatment is regulated compared to other chronic conditions. As Watkins points out, patients with high blood pressure or diabetes do not need to see their doctors every time they refill prescriptions. Instead, they receive ongoing care with routine monitoring. Addiction, however, is often treated with more suspicion and stigma.
By easing restrictions during the pandemic, regulators demonstrated that patients can safely access MAT through telehealth. The result has been higher engagement, better adherence, and fewer barriers to care. Providers believe these outcomes prove that flexibilities should not end with the public health emergency.
Patient-Centered Benefits
Patients themselves have seen significant benefits. Telehealth removes many of the logistical challenges tied to treatment, such as transportation, scheduling, and stigma. It also allows for more privacy, giving patients control over their recovery journey without external pressures.
For many low-income and rural patients, these changes represent more than just convenience—they represent access. Without permanent telehealth options, many would struggle to start or continue treatment, risking relapse and worsening health outcomes.
What Needs to Happen Next
For long-term change, providers are calling on federal and state regulators, as well as insurers, to make COVID-19 flexibilities permanent. This includes:
- Allowing tele-prescriptions for buprenorphine beyond the pandemic.
- Expanding telehealth reimbursement for MAT and group counseling.
- Considering safe, regulated options for methadone tele-prescribing.
- Supporting reimbursement for co-occurring mental health disorders.
By institutionalizing these reforms, the healthcare system can ensure that patients continue to benefit from the accessibility and equity created during the pandemic.
An Uncertain Future
The future of MAT access remains uncertain. Some telehealth practices can continue regardless of federal policy, such as virtual pill counts and remote check-ins. However, key flexibilities like tele-prescriptions for buprenorphine and reimbursement for tele-IOP programs depend heavily on government action and insurer policies.
Providers worry that without permanent change, many patients will lose access to care. As Watkins explained, half of the patients currently being treated virtually at Pathways might not continue treatment if they had to return to in-person sessions. That could leave them without lifesaving care in the midst of an ongoing addiction crisis.
Conclusion
The COVID-19 pandemic highlighted both the fragility and adaptability of the substance use disorder treatment system. Emergency flexibilities demonstrated that MAT can be safely and effectively delivered through telehealth, improving patient access and outcomes.
For providers like Pathways, Intermountain, and Pinnacle Treatment Centers, the lessons of the pandemic are clear: patients thrive when barriers are removed, stigma is reduced, and care is made more accessible. As the nation looks beyond the pandemic, policymakers face a critical choice—return to restrictive pre-COVID regulations or embrace a more equitable future for MAT delivery.
For many in the field, the answer is simple. The pandemic has shown that permanent flexibility in MAT access is not just possible but necessary to save lives and create a stronger, more compassionate system of care.
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