The substance use disorder (SUD) treatment landscape is facing monumental changes in 2025, with several critical regulations poised to reshape the way care is delivered to individuals battling addiction. From the future of telehealth policies to the shifting political landscape, providers, policymakers, and advocates are preparing for a transformative year that could either advance or hinder the progress made in the fight against addiction. At the heart of these changes are two significant factors: the future of telemedicine prescribing policies and the potential regulatory impact of a new administration.
The Critical Role of Telehealth Policies
Perhaps the most pressing issue for the SUD treatment industry in 2025 is the future of telehealth addiction treatment regulations. In response to the COVID-19 pandemic, the Drug Enforcement Administration (DEA) temporarily lifted restrictions on prescribing controlled substances via telehealth, a policy that has been critical in expanding access to medication-assisted treatment (MAT). This provision allowed healthcare providers to prescribe medications like buprenorphine, a key treatment for opioid use disorder (OUD), without requiring patients to come in for in-person visits. This policy has been transformative in overcoming barriers to treatment, particularly for individuals living in rural or underserved areas.
However, this temporary policy is set to expire at the end of 2025, leaving the future of telemedicine prescribing in limbo. David C. Guth, Jr., CEO of Centerstone, emphasizes the importance of the policy in expanding access to care: “This extension enables providers to continue offering MAT for SUD through telehealth, which has been incredibly effective in eliminating barriers to care.” The change also aligns with the elimination of the waiver requirement for prescribing Suboxone, a crucial step in improving access to MAT. But, with the expiration date fast approaching, the question remains: will these provisions become permanent, or will they be rolled back?
The DEA’s efforts to rescind telemedicine access for buprenorphine have met significant opposition from health advocates, physicians, and bipartisan members of Congress. In response to a leaked proposal earlier this year, the backlash was swift and widespread, calling for the continuation of telehealth addiction treatment regulations as a critical tool in addiction treatment. Despite a temporary extension, the industry remains in a precarious position. Stephanie Strong, founder and CEO of Boulder Care, argues that legislative action is necessary: “We hope the TREATS Act will gain momentum to make this critical modality for addiction medicine permanent.” The TREATS Act (Telehealth and Treatment for Addiction Act) is a key piece of proposed legislation designed to safeguard telehealth addiction treatment regulations. Advocates hope that by 2025, this legislation will provide the certainty and stability needed to continue providing MAT via telehealth.
The shift to telehealth has proven to be not just a pandemic-era solution but a lasting change that has revolutionized addiction treatment. Providers have been able to connect with patients more easily, offering flexibility that has made it easier for people to stay on track with their treatment plans. The potential rollback of these policies would be devastating to many patients who rely on telehealth addiction treatment regulations for their care. As Ankit Gupta, founder and CEO of Bicycle Health, points out, “In 2025, we’ll need to continue to prove these care models work and lobby for evidence-based rulemaking or Congressional actions that take into account the real experiences of Americans struggling with OUD.”
Medicaid and the Changing Political Landscape
Alongside the uncertainty surrounding telehealth, changes in the political landscape also promise to influence the future of SUD treatment. A new administration in the White House often signals shifts in policy priorities, and 2025 is no different. One of the most significant areas of focus will be Medicaid, the government insurance program that covers millions of Americans, including many individuals with SUD. With Medicaid beneficiaries representing a disproportionate share of individuals suffering from addiction, any changes to Medicaid policy could have far-reaching consequences for the treatment of SUD.
Cooper Zelnick, president of Groups Recover Together, highlights the critical role Medicaid plays in treating SUD, stating, “Nearly 12% of Medicaid beneficiaries over 18 have a diagnosed SUD.” This statistic underscores the importance of Medicaid in providing affordable access to treatment for those who need it most. The question, however, is how the new administration will approach Medicaid policies, particularly with the potential appointment of Dr. Mehmet Oz, a well-known TV personality, to head the Centers for Medicare & Medicaid Services (CMS). Under new leadership, CMS could make “meaningful” changes to Medicaid policies, either improving access to care or creating new hurdles for providers and patients alike.
For many advocates and providers, the uncertainty surrounding Medicaid is cause for concern. Changes in Medicaid administration could lead to differences in how benefits are distributed or how treatment providers are reimbursed. While some experts believe that Medicaid reforms could lead to improved outcomes for individuals with SUD, others worry that changes could disproportionately harm the most vulnerable populations. Zelnick notes, “Policy changes to how states administer benefits can lead providers to meaningfully change operations, ideally to improve outcomes for members.”
In addition to Medicaid, the ongoing conversation surrounding the Affordable Care Act (ACA) and its impact on addiction treatment will also play a critical role in the regulatory outlook for 2025. The ACA has been instrumental in expanding access to mental health and addiction treatment services, ensuring that insurers cover SUD care. However, with promises from the incoming administration to focus on deregulation and repeal of certain aspects of the ACA, providers are concerned about how these changes might affect coverage for addiction treatment services. John Driscoll, president and CEO of Caron Treatment Centers, cautions, “Without a doubt, the approach to the ACA and parity regulations could really impact whether and how treatment is accessed in the coming years.”
The Risk of a Fragmented System
Perhaps one of the most significant risks posed by the changing regulatory environment is the potential for a fragmented, patchwork system that could complicate care delivery across state lines. Driscoll warns, “I’m concerned about the potential that there will be a reduction of federal oversight, instead allowing individual states to set regulations.” While some states have the infrastructure to absorb this additional responsibility, the majority do not, making it harder for providers to offer consistent care. For multi-state providers, navigating a patchwork of state regulations could become costly and administratively burdensome, potentially limiting their ability to operate in multiple states.
A fragmented system would also make it more difficult for patients to access consistent, quality care, particularly for those who rely on out-of-state providers. Driscoll’s concern is that this could create an uneven playing field, where some states have robust systems in place to address addiction while others lack the resources to do so effectively. This scenario could have devastating consequences for families in need of treatment, further exacerbating the addiction crisis.
Looking Ahead: The Need for Action
As we look toward 2025, it is clear that the future of SUD treatment is in the hands of lawmakers, regulatory bodies, and healthcare providers. The regulatory changes on the horizon – particularly those concerning telehealth addiction treatment regulations and Medicaid – have the potential to either strengthen or destabilize the existing treatment infrastructure. With so much at stake, industry leaders are calling for evidence-based policies that reflect the realities of addiction treatment and the needs of those struggling with SUD.
The urgency of these issues cannot be overstated. As Ankit Gupta points out, “The burden of the substance use disorder epidemic disproportionately falls on Medicaid beneficiaries and the uninsured.” These individuals are already facing tremendous barriers to care, and any regulatory changes that hinder access to treatment will only make their struggles more difficult. In order to ensure that addiction treatment remains accessible and effective, policymakers must prioritize evidence-based solutions, maintain oversight of Medicaid and ACA policies, and work to ensure that telehealth addiction treatment regulations become a permanent fixture in addiction care.
The next few years will be critical in shaping the future of SUD treatment, and the decisions made in 2025 will reverberate for years to come. As the industry faces an uncertain regulatory environment, providers, advocates, and patients alike are calling for action, hoping that the lessons learned over the past few years will guide a future that prioritizes accessible, effective, and compassionate addiction treatment for all.
