Medication-based treatment has long been recognized as the gold standard for treating opioid use disorder (OUD). Medications like buprenorphine are widely regarded for their ability to reduce cravings, manage withdrawal symptoms, and help individuals abstain from illicit opioid use. However, despite its proven effectiveness, many patients still struggle to access this critical treatment. As a result, some individuals turn to diverted medications—prescriptions intended for someone else—in an attempt to self-medicate and manage their addiction.
A new study published in Substance Use & Misuse has raised important concerns regarding this issue, revealing that nearly half of patients entering virtual OUD treatment programs were already taking buprenorphine, with almost 40% obtaining the medication through diversion. The study, conducted by researchers affiliated with Bicycle Health, a virtual treatment provider for OUD, underscores the urgent need to expand access to legitimate, prescribed buprenorphine and other medication-based treatments.
The Growing Challenge of Buprenorphine Diversion
When discussing the expansion of access to medications like buprenorphine, concerns about diversion—the act of obtaining medication without a legitimate prescription—often arise. However, Dr. Brian Clear, chief medical officer of Bicycle Health, suggests that the reality of buprenorphine diversion is different from that of other controlled substances. While some may fear that diversion could lead to misuse or abuse, Dr. Clear points out that many individuals who use diverted buprenorphine do so to manage withdrawal symptoms and prevent relapse into illicit opioid use, rather than to get high.
The issue, however, is multifaceted. While these patients may find temporary relief from withdrawal symptoms, they may not be receiving the full therapeutic benefits of the medication. Buprenorphine works best when accompanied by comprehensive treatment that includes therapy, counseling, and peer support, all of which are often lacking when individuals rely on diverted medications. As a result, those using diverted buprenorphine may not be receiving the optimal care necessary for long-term recovery.
Bicycle Health, a telehealth-based provider that offers medications for OUD (MOUD), therapy, and peer support groups via virtual care, is working to address these issues by providing legitimate, medically supervised treatment. With $83 million in funding since its founding in 2017, the company has been at the forefront of expanding access to virtual OUD treatment and advocating for the importance of medication-based recovery.
New Research Highlights the Need for Expanded Access
The new study published by Bicycle Health offers critical insights into the prevalence of diverted buprenorphine among OUD patients. Researchers analyzed electronic health record (EHR) data from the first 500 patients enrolled in Bicycle Health’s virtual treatment program in January 2023. The results were revealing: 232 of the 500 patients (about 46%) were already using buprenorphine when they entered the program. Of those, 92 patients (18.4% of the total group) reported obtaining the medication through diversion.
These findings are concerning for several reasons. First, they highlight the widespread use of diverted buprenorphine, especially among individuals seeking formal treatment. Second, they underscore the need for greater access to legitimate prescriptions for buprenorphine and other medications that can help individuals recover from OUD. When patients turn to diverted medications, they often miss out on the broader support services, including therapy and peer counseling, which are vital for sustained recovery.
The study also highlights the growing role of telehealth in addiction treatment. Bicycle Health’s virtual platform allows patients to receive buprenorphine prescriptions, therapy, and peer support remotely, making it easier for individuals to access the treatment they need, even if they live in underserved or rural areas. This is especially important in light of recent proposals from the U.S. Drug Enforcement Administration (DEA) that could restrict telehealth prescribing of buprenorphine in 2025.
The Importance of Telehealth Flexibilities
The DEA’s proposal to limit telehealth in addiction treatment could significantly impact access to care for individuals with OUD. Currently, under COVID-era flexibilities, patients can receive buprenorphine prescriptions via telehealth without the need for an in-person visit. However, the DEA is considering a return to pre-pandemic regulations that would require in-person consultations before prescribing buprenorphine. The idea behind this policy change is to limit diversion by ensuring that medications are only prescribed after a face-to-face evaluation.
While the intention behind the proposal is to curb diversion, Bicycle Health’s experience suggests that it may not be as effective as intended. According to the company, many patients initiating care through telehealth in addiction treatment are already using diverted buprenorphine when they come for treatment. Some individuals even seek telehealth services specifically to discontinue the use of diverted buprenorphine and obtain a valid prescription. By making telehealth more difficult to access, the DEA’s proposal could inadvertently leave many patients without treatment options, exacerbating the challenges they face in accessing safe and effective care.
Fortunately, in November 2024, the DEA extended its telehealth flexibilities until the end of 2025. This decision provides continued access to virtual care for individuals with OUD, ensuring that they can receive the medications and support they need without unnecessary barriers. The extension is a win for both patients and treatment providers, who argue that telehealth in addiction treatment has played a crucial role in improving access to care and reducing the risks associated with diversion.
The Case for Permanently Extending Telehealth Access
There is growing momentum within the OUD treatment community to make telehealth in addiction treatment permanent. Many treatment providers and industry groups are lobbying for telehealth to remain a viable option for prescribing buprenorphine and other medications for OUD. The evidence suggests that telehealth has significantly improved access to care, particularly for individuals living in rural areas or those with limited transportation options. Moreover, it allows patients to receive care from the comfort and privacy of their own homes, reducing the stigma often associated with seeking treatment for addiction.
Telehealth also allows for more flexible and timely access to medications, helping patients avoid the disruptions that can occur when they are unable to access care in person. For individuals with OUD, this flexibility is critical, as it enables them to continue their treatment without delays, ensuring that they stay on track with their recovery goals.
A Path Forward: Expanding Access to Medication-Based Treatment
As the opioid epidemic continues to take a devastating toll on communities across the country, it is essential that we prioritize access to evidence-based treatments like buprenorphine. The new research from Bicycle Health serves as a powerful reminder of the challenges patients face when trying to access legitimate treatment for OUD. While buprenorphine is highly effective, many patients still turn to diverted medications due to the difficulty of obtaining a prescription through traditional means.
To address this issue, it is crucial that policymakers and healthcare providers work together to expand access to medication-based treatments. This includes supporting telehealth in addiction treatment and ensuring that patients have access to the full spectrum of care, including therapy and peer support. By reducing barriers to treatment and improving access to comprehensive care, we can help more individuals achieve lasting recovery and ultimately save lives.
The time to act is now. Expanding access to buprenorphine and other medications for OUD can help reduce diversion, improve patient outcomes, and provide individuals with the tools they need to build a brighter, healthier future free from opioid addiction.
