ACLGIM Leadership Forum

Clinical Innovations

Buprenorphine Telehealth Advocacy: Telephone-Only Treatment Essential to Addressing Disparities

Dr. Suen (leslie.suen@ucsf.edu) is a National Clinician Scholars Program fellow at the University of California, San Francisco, and a scholar in the Society of General Internal Medicine’s Leadership in Health Policy Program (LEAHP) 2021-22 cohort. Dr. Kasanagottu (kkasanag@bidmc.harvard.edu) is a General Medicine and Primary Care Fellow at Harvard Medical School and Beth Israel Deaconess Medical Center and a scholar in the Society of General Internal Medicine’s Leadership in Health Policy Program (LEAHP) 2021-22 Cohort.

Primary care physicians are seeing a growing number of patients struggling with opioid use disorder (OUD). COVID-19 exacerbated the overdose crisis, where drug overdose deaths skyrocketed in 2020, claiming almost 100,000 lives.

One of the few effective medications for treating OUD is buprenorphine, with greater than 50% mortality reduction; however, several barriers make accessing this life-saving treatment impossible for some. Only 5% of physicians are licensed to prescribe. More than half of rural counties (those most in need) lack access to a prescriber. Racial disparities exist, where Black adults have 77% lower odds of being prescribed buprenorphine than white adults.

Telemedicine poses a potential solution to meet patient care needs during the pandemic. The federal government eased restrictions to improve access to buprenorphine in March 2020. For the duration of the COVID-19 public health emergency, in-person visits are no longer required to initiate buprenorphine. Instead, licensed prescribers can initiate and maintain buprenorphine treatment through video- or telephone-only visits.

The telephone-only provision is key, as studies show populations with the highest disparities for OUD treatment, including Black, rural, and publicly insured communities, are most likely to lack broadband Internet access. These populations have relied heavily on telephone-only visits to access care during the pandemic. In our practices, offering telephone-only buprenorphine treatment has been a game changer, leading to increased prescriptions for at-risk individuals.

Extending telephone-only buprenorphine care beyond the pandemic is essential. Congress is considering permanent changes through the TREATS Act, which would maintain buprenorphine telehealth. However, this proposed legislation still requires the initial visit to be video-enabled or in-person, precluding buprenorphine access for tens of thousands of Americans.

Physicians grappling with the devastating overdose crisis should compel their elected officials to support telephone-only buprenorphine treatment. Buprenorphine telehealth equity can and should be maintained.


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