Dialing In or Dialing Out? Navigating Telemedicine Law and Access to Buprenorphine
In Dialing In or Dialing Out? The Relationship Between State Telemedicine Law and Access to Buprenorphine, Professor Stacey A. Tovino of the University of Oklahoma College of Law presents an essential, data-driven analysis of how state-level telemedicine regulations are influencing access to buprenorphine—a life-saving medication used to treat opioid use disorder (OUD). The article, published in the Texas A&M Law Review, is based on an original and comprehensive 50-state survey and offers timely insights into the current legal landscape following the expiration of the COVID-19 public health emergency (PHE).
A Fragmented Legal Landscape
One of the article’s most significant findings is the lack of uniformity in state laws governing the tele-induction and tele-prescription of buprenorphine. While eight states have laws that expressly permitthe tele-induction of buprenorphine—or medications for the treatment of OUD or substance use disorder (SUD)—other states fall along a spectrum of regulatory uncertainty:
- Some have implied permissions, requiring legal interpretation.
- Others impose restrictionson certain patient populations or types of prescribers.
- A few prohibit tele-induction outright, regardless of federal flexibility.
This state-by-state variation, described by Tovino as a “glaring patchwork,” creates confusion for providers and patients alike. Moreover, the sources of legal authority are heterogenous—ranging from formal statutes and regulations to medical board opinions, agency letters, and even email communications.
Federal Flexibilities vs. State Restrictions
Following the pandemic, the DEA and HHS extended federal telemedicine flexibilities through December 31, 2025. These allow for the initiation and continuation of buprenorphine treatment via telehealth, provided certain conditions are met. However, states retain the power to impose more stringent rules. Tovino’s article shows that many have done exactly that—undermining the spirit, if not the letter, of federal policy.
For example, some states require in-person examinations before a prescription can be issued. Others limit telehealth prescribing to certain types of facilities or professionals. These legal barriers disproportionately affect rural, disabled, and socioeconomically disadvantaged populations—those least able to travel to brick-and-mortar clinics for OUD treatment.
The Myth of Diversion and the Case for Telehealth
A recurring rationale for restrictive state laws is the fear of medication “diversion,” or the misuse of prescribed buprenorphine. However, Tovino demonstrates that there is no clear evidence that telehealth-only care leads to increased diversion. In fact, studies suggest the opposite: that broader access to telehealth reduces the need for unregulated sources and may enhance patient safety and satisfaction.
She also emphasizes that retention in treatment—a key determinant in reducing overdose risk and mortality—is significantly improved when patients have access to telehealth services.
Recommended Statutory Language for Reform
To resolve the current confusion and inequity, Tovino offers recommended statutory language designed to bring clarity and consistency to state telemedicine policies. This language mirrors the structure and clarity of provisions already adopted by states that expressly permit the tele-induction of buprenorphine or similar medications for OUD or SUD.
“Prescription medications, including controlled substances, for use in treatment of opioid use disorder may be prescribed via telehealth by all authorized prescribers and for all patients in the state. Patients who are prescribed medications for the treatment of opioid use disorder may be monitored via telehealth. No in-person visits are required.”
Tovino advises against limiting this language only to buprenorphine, cautioning that future medications may also require flexible telehealth pathways.
In addition to enacting clear authorizations, states should also require public notice of the legality of tele-prescription practices. Patients and providers alike need accessible information, not regulatory ambiguity.
A Legislative Imperative
As the article makes clear, ongoing legal instability—exacerbated by frequent state-level policy changes—undermines treatment continuity. Patients often lose access to buprenorphine due to confusion or abrupt shifts in legal standards. Such disruptions are not just administrative burdens; they are threats to public health and safety.
Professor Tovino’s analysis and recommendations serve as a crucial resource for lawmakers, health care providers, and advocates working to expand access to OUD treatment. With overdose deaths still at crisis levels, aligning state law with evidence-based practices and federal flexibilities is not only smart—it’s urgent.