Forty-five state attorneys general are joining forces to urge federal agencies to maintain the COVID-era rules that expanded virtual addiction treatments. In a letter organized by the National Association of Attorneys General (NAAG), the group pressed the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) to preserve flexibilities that have become critical for patients seeking care.
The letter specifically calls on the DEA and SAMHSA to follow through on a June 2022 announcement. At that time, SAMHSA said it would allow opioid treatment programs (OTPs) to continue prescribing buprenorphine via telehealth even after the federal public health emergency (PHE) ended. However, months later, no concrete steps have been taken to codify that change. Attorneys general expressed concern that without action, patients could lose access to a vital form of treatment.
“Today, the delivery of care for buprenorphine treatment has shifted significantly to telehealth, making it more accessible than ever for individuals to access the treatment they need,” the letter read. Their message reflects the growing consensus that virtual addiction treatments should remain part of the national strategy for addressing the opioid crisis.
The Overdose Crisis: Why Access Matters
The push for continued telehealth access comes amid one of the deadliest chapters in America’s overdose epidemic. Since the start of the pandemic, overdose deaths have risen sharply, climbing by 42%. Synthetic opioids, particularly fentanyl, are driving much of this increase, but alcohol and polysubstance use have also contributed.
For many, telehealth provided a lifeline during the pandemic when in-person treatment was difficult or impossible to access. It allowed patients with opioid use disorder (OUD) to connect with licensed providers, begin or maintain medication-assisted treatment, and receive counseling and support remotely. Without this flexibility, countless individuals might have been left untreated — and at higher risk of overdose or relapse.
This context makes the attorneys general’s letter more than just a policy request. It represents a critical public health intervention at a time when the country cannot afford to reduce access to proven virtual addiction treatments.
How Virtual Addiction Treatments Took Root
Before COVID-19, federal regulations required an in-person medical evaluation before a provider could prescribe controlled medications for opioid treatment. This created a significant barrier for patients in rural areas, those without transportation, and individuals who faced stigma in seeking care.
In April 2020, as COVID-19 spread and health systems strained, SAMHSA temporarily waived the in-person requirement. OTPs were allowed to use telehealth to initiate and monitor buprenorphine treatment when clinically appropriate. The change was intended to prevent disruption of care during the public health emergency — but it also opened the door to a new era of accessibility.
For many patients, telehealth eliminated logistical hurdles like commuting to clinics or arranging childcare. For providers, it offered a way to reach more people in need, particularly in areas with limited treatment infrastructure. This flexibility quickly proved to be not just a pandemic workaround but a potentially transformative tool for addiction care. The demand for virtual addiction treatments has only continued to grow as patients see the benefits of easier access and ongoing support.
The Rise of Digital Addiction Treatment Companies
The regulatory shift also sparked growth in digital health innovation. A new generation of addiction treatment startups began offering telehealth-based programs for substance use disorder. Companies like Quit Genius, Boulder Care, Ria Health, Bicycle Health, and Brave Health collectively raised about $179 million in funding since June 2022, reflecting investor confidence in the long-term viability of virtual addiction treatments.
These companies emphasize patient convenience, privacy, and continuous support. Most combine medication-assisted treatment (MAT) with teletherapy, digital monitoring, and peer support networks. For patients hesitant to seek in-person treatment due to stigma or distance, these platforms have made recovery more accessible.
The success of these ventures underscores the demand for virtual options. Scaling back telehealth flexibilities could not only disrupt patient care but also hinder the momentum of innovation in the addiction treatment space.
Federal Inaction Raises Concerns
While SAMHSA initially committed to preserving some of these flexibilities, the lack of follow-through has sparked frustration. Attorneys general point to the June 2022 announcement as a promise yet to be honored. Without formal rulemaking or updated regulations, the ability of providers to prescribe via telehealth remains vulnerable.
Advocacy organizations and professional associations have echoed these concerns. Earlier this month, the American Telemedicine Association, backed by 110 organizations including the American Psychiatric Association, Bicycle Health, Lifepoint Health, and The Kennedy Forum, sent its own letter to the DEA and U.S. Attorney General Merrick Garland. Their message was clear: prescribing flexibilities for controlled substances must continue to support virtual addiction treatments.
Congress has also entered the debate. Members of the Bipartisan Addiction and Mental Health Task Force — led by Representatives Ann McLane Kuster (D-N.H.) and Lori Trahan (D-Mass.) — pressed SAMHSA and DEA to allow practitioners to initiate buprenorphine treatment through audio-only telehealth visits. They also asked the agencies to provide a timeline for permanent action, signaling growing impatience with delays.
The Methadone Question
While buprenorphine has been the focus of much of this advocacy, another key medication for OUD — methadone — remains tightly controlled. Methadone can only be prescribed and dispensed through certified OTPs, and unlike buprenorphine, it did not receive the same telehealth flexibilities during the pandemic.
Advocates have long argued that methadone should be more accessible, including through telehealth induction, especially given its decades-long track record in treating opioid addiction. However, federal agencies have cited overdose risks as the main reason for maintaining restrictions. This debate highlights the tension between expanding access and ensuring patient safety — a balance that will continue to shape policy around virtual addiction treatments.
State-Level Divides
Although 45 state attorneys general signed the NAAG letter, five did not. Some of these states, including Tennessee and Alabama, have taken steps to restrict telehealth by barring out-of-state physicians from practicing virtually. These moves reflect broader political and regulatory divides over the role of telehealth in health care.
Such restrictions could complicate national efforts to create consistent rules for virtual addiction care. Patients living in states with more restrictive policies may find themselves at a disadvantage, highlighting the uneven access that could emerge if federal agencies fail to set clear, nationwide standards for virtual addiction treatments.
The Public Health Emergency Timeline
The future of telehealth rules is also tied to the status of the federal public health emergency. The PHE, first declared in early 2020, has been renewed every 90 days across both the Trump and Biden administrations. Each time, the Department of Health and Human Services (HHS) has pledged to give at least 60 days’ notice before allowing it to expire.
On October 13, 2022, HHS Secretary Xavier Becerra renewed the PHE through January 11, 2023. Given the administration’s prior commitments, it is widely expected that another extension will follow. Still, the uncertainty surrounding each renewal leaves providers and patients anxious about the continuity of care. Without permanent regulatory changes, every PHE deadline brings the risk of disruption to virtual addiction treatments.
What’s at Stake
The attorneys general’s letter, combined with pressure from advocacy groups, medical organizations, and lawmakers, makes one thing clear: the stakes are high. If telehealth flexibilities are rolled back, patients could lose access to lifesaving treatment, particularly in underserved communities.
The overdose crisis is not abating. With deaths climbing at alarming rates, experts stress that now is not the time to add barriers to care. Instead, they argue, policymakers should build on the lessons of the pandemic and integrate virtual addiction treatments into the long-term strategy for combating addiction.
Looking Ahead
The DEA and SAMHSA face a pivotal decision. On one side is a growing coalition calling for action — attorneys general, telehealth providers, addiction specialists, and patient advocates who see virtual care as essential to saving lives. On the other side are lingering concerns about safety, oversight, and regulatory precedent.
As federal agencies weigh their options, the message from most states and advocacy groups is clear: virtual addiction treatments have proven their value, and rolling back access could have devastating consequences. The question now is whether the federal government will move quickly enough to turn temporary flexibilities into permanent solutions.
Until then, patients, providers, and policymakers alike will be watching closely, knowing that the future of addiction treatment — and countless lives — hangs in the balance.
