Virtual medication-assisted treatment (Virtual MAT) providers have witnessed a transformative moment during the COVID-19 pandemic, propelled by regulatory changes that dramatically expanded access to critical opioid use disorder treatments such as buprenorphine. These temporary flexibilities allowed providers to reach patients remotely, overcoming many traditional barriers to care. But as the pandemic emergency declarations wind down, the question on many providers’ minds is whether these regulatory accommodations will remain in place — or if the sector will face a return to more restrictive rules.
Pandemic-Era Regulatory Changes Accelerated Virtual MAT Adoption
Prior to the pandemic, the Ryan Haight Act imposed strict limitations on tele-prescribing controlled substances, requiring an initial in-person visit followed by in-person follow-ups every 24 months. This significantly limited the scalability of Virtual MAT, as providers had to meet patients face-to-face before prescribing medications like buprenorphine, the gold standard for opioid use disorder treatment.
In March 2020, the Drug Enforcement Administration (DEA) waived this key provision in response to the public health emergency. This waiver removed the in-person visit requirement, allowing Virtual MAT providers to initiate treatment and prescribe controlled substances remotely. The relaxation of these regulations, combined with similar state-level temporary flexibilities, unleashed rapid growth in telehealth behavioral health services.
Boston-based Bicycle Health serves as a strong example of how regulatory changes enabled innovation. Originally operating on a hybrid model of in-person and virtual visits, Bicycle Health pivoted to fully telehealth-based care during the pandemic. According to Founder and CEO Ankit Gupta, this shift improved the quality of care by eliminating barriers such as transportation difficulties, scheduling conflicts, and the stigma often associated with in-person addiction treatment visits. Virtual MAT made treatment more accessible and convenient, integrating seamlessly into patients’ daily lives while also reducing costs.
State Responses and the Impact of the Public Health Emergency Expiration
About 15 states have laws similar to the Ryan Haight Act that regulate tele-prescribing of controlled substances. During the pandemic, many of these states introduced temporary flexibilities to align with federal waivers, and some have even taken steps toward permanent regulatory change. Florida, for example, recently amended its laws to allow telehealth providers to prescribe controlled substances without an in-person visit, signaling growing acceptance of telehealth as a core treatment delivery model.
The federal public health emergency (PHE) declared by the U.S. Department of Health and Human Services (HHS) under the Trump administration enabled these regulatory flexibilities to take hold. The PHE has been extended multiple times but is slated to expire in July. While many COVID-era rules will end with the PHE, the DEA waiver of the in-person requirement for prescribing controlled substances is not directly linked to the PHE’s duration. This suggests that Virtual MAT providers may be able to maintain current levels of access even as the pandemic recedes.
DEA’s Commitment to Expanding Virtual MAT Access Amid the Overdose Crisis
The DEA has made clear its recognition of the critical role Virtual MAT plays in combating the nation’s ongoing overdose crisis. According to recent Centers for Disease Control and Prevention (CDC) data, more than 107,000 people died from drug overdoses in the 12 months ending November 2023—the highest number ever recorded. Illicit fentanyl, a powerful synthetic opioid, continues to flood the black market and drive these deaths.
In response, DEA Administrator Anne Milgram issued a statement emphasizing the agency’s priority to save lives through expanded access to medication-assisted treatment. She declared that the DEA’s goal is to make Virtual MAT “readily and safely available to anyone in the country who needs it.” This marks an important shift from earlier, more cautious approaches to controlled substance prescribing.
However, the DEA has yet to fully implement the special registration process mandated by the 2018 SUPPORT Act. This process would officially authorize qualified providers to prescribe controlled substances via telehealth without an initial in-person visit, effectively codifying the pandemic waivers into permanent regulations. The deadline for this registration was October 2019, and advocates have urged the DEA to act swiftly to provide clarity and security for providers of Virtual MAT.
Preparing for an Uncertain Regulatory Future in Virtual MAT
Despite the positive signs, Virtual MAT providers remain cautious and are developing contingency plans in case regulatory winds shift. Zack Gray, CEO of New York City-based Virtual MAT provider Ophelia Health, highlights concerns about the timing and content of the DEA’s forthcoming registration rules. There is a risk that the rules could be overly burdensome or not fully aligned with current clinical evidence, which could stifle innovation and reduce access.
If the Ryan Haight Act’s original in-person visit requirements return, Virtual MAT companies would face significant operational challenges. For example, Ophelia Health primarily treats opioid use disorder with Suboxone (buprenorphine and naloxone), a Schedule III medication. However, other telehealth companies are prescribing Schedule II substances like Adderall on a large scale, which may raise regulatory scrutiny. Gray points out that the government may view providers prescribing highly controlled medications via telehealth differently than those focused on Virtual MAT, further complicating the landscape.
If in-person visits become mandatory again, rural areas—the communities with some of the greatest unmet needs—would be particularly impacted. Establishing physical clinics in sparsely populated regions is expensive and logistically difficult. Gray envisions partnerships with local providers or concentrating services in urban centers as alternative strategies. Additionally, offering complementary services like long-acting injectable medications or primary care could help Virtual MAT providers maximize the value of any physical locations.
Bicycle Health’s network of in-person clinics across 23 states positions it well to comply if in-person requirements return. Gupta confirms the company could meet these mandates immediately if needed, reflecting a hybrid care model that balances virtual and face-to-face treatment.
A Path Toward Permanent, Expanded Access to Virtual MAT
The future of Virtual MAT regulations hinges on a blend of political will, regulatory action, and public health needs. President Joe Biden has made the opioid epidemic a top priority, emphasizing it during his State of the Union address as part of his administration’s “Unity Agenda.” This high-level attention increases the likelihood that federal policymakers will work to preserve and expand telehealth flexibilities for addiction treatment.
Leaders in the Virtual MAT space largely agree that the current environment favors long-term regulatory reform. As Zack Gray notes, the Ryan Haight Act is an outdated law from a pre-telemedicine era that no longer fits today’s realities. The momentum built during the pandemic has opened new avenues for delivering life-saving treatment more broadly and equitably.
However, the exact shape of future policies remains uncertain. Virtual MAT providers must continue engaging with regulators, advocating for science-based rules, and preparing for multiple scenarios to ensure patients don’t lose access to essential care.
Conclusion
The pandemic accelerated an overdue transformation in how medication-assisted treatment can be delivered, breaking down barriers that have historically limited access to effective opioid use disorder care. While the expiration of the public health emergency raises questions, current signals from the DEA and lawmakers suggest that expanded access to Virtual MAT could become a permanent fixture in the U.S. healthcare system.
As the overdose crisis worsens, ensuring that innovative models like Virtual MAT can thrive is critical to saving lives. Providers like Bicycle Health and Ophelia Health are leading the way, navigating regulatory complexities and pushing for reforms that will sustain and grow telehealth’s role in combating opioid addiction. The coming months and years will be crucial in determining how flexible and accessible the MAT landscape becomes — with millions of lives potentially hanging in the balance.
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