New Research Challenges the Myth: Expanded Telehealth Access Does Not Increase Drug Diversion
As the Drug Enforcement Administration (DEA) approaches a critical decision on telehealth prescribing waivers at the end of 2025, groundbreaking research sponsored by the Center for Telehealth & e-Health Law (CTeL) in collaboration with Charm Economics provides compelling evidence that expanded telehealth access does not contribute to increased drug diversion. Contrary to long-standing concerns, this study indicates that telehealth expansion—supported through payment parity laws—may actually reduce overdose rates by improving access to treatment for opioid use disorder (OUD) and other substance use disorders (SUDs).
The Growing Role of Telehealth in Substance Use Disorder Treatment
Telehealth has transformed healthcare accessibility, particularly in the treatment of SUDs, including OUD. The COVID-19 pandemic accelerated the adoption of virtual care, allowing patients—especially in rural and underserved communities—to receive life-saving treatment without the barriers of stigma, transportation, and provider shortages. Multiple studies have already demonstrated that telehealth increases patient retention in treatment programs, directly correlating with better recovery outcomes and fewer overdose deaths.
However, concerns persist that the expansion of telemedicine—especially with the ability to prescribe controlled substances virtually—could lead to increased drug diversion, in which prescribed medications end up in the hands of individuals for whom they were not intended. This study sought to empirically assess whether these concerns are warranted.
The Research: A Data-Driven Approach
The study utilized a state-level difference-in-difference analysis between 2018 and 2022, focusing on states that implemented telehealth payment parity laws—policies requiring insurers to reimburse telehealth visits at the same rate as in-person visits. Researchers analyzed overdose rates before and after payment parity implementation, comparing states with new parity laws to similar states without them.
Key Comparisons:
Kansas (parity implemented in 2019) vs. Missouri (no parity law during study period)
Illinois (parity implemented in 2021) vs. Indiana (parity law implemented earlier in 2015)
The analysis leveraged data from the CDC’s Drug Overdose Surveillance and Epidemiology (DOSE) System, as well as demographic and socioeconomic data from federal sources.
Findings: Telehealth Expansion Correlates with Reduced Overdose Rates
The study found no evidence that expanded telehealth access increased drug diversion. Instead, the results demonstrated a small but statistically significant reduction in overdose rates following the implementation of payment parity laws:
Kansas saw a reduction of 1.28 overdoses per 100,000 population per month relative to Missouri.
Illinois experienced a reduction of 2.16 overdoses per 100,000 population per month relative to Indiana.
These findings align with previous studies, such as those by Huskamp et al. (2023) and Uscher-Pines et al. (2022), which found that telehealth expansion increased treatment retention and decreased opioid-related overdose deaths. By improving access to evidence-based treatment options such as buprenorphine therapy, telehealth plays a vital role in harm reduction rather than fueling drug diversion.
Implications for Policy and the Future of Telehealth Regulations
This research carries significant implications as the DEA considers whether to finalize or extend telehealth prescribing waivers beyond 2025. Policymakers have long debated whether loosening telehealth restrictions could contribute to increased misuse of controlled substances. This study provides robust empirical evidence that expanded telehealth access—rather than exacerbating drug diversion—actually contributes to lower overdose rates by improving access to treatment.
Given the study’s findings, policymakers should consider the following:
Maintain and Expand Telehealth Prescribing Flexibilities: Limiting virtual prescribing options could disrupt care for thousands of patients who rely on telehealth for SUD treatment.
Encourage Payment Parity for Telehealth Services: Ensuring fair reimbursement rates can incentivize more healthcare providers to offer telehealth-based treatment, increasing access to care.
Invest in Telehealth Infrastructure and Research: Further studies should continue evaluating long-term impacts, ensuring that regulatory policies reflect real-world data rather than outdated assumptions.
Conclusion
This first-of-its-kind research decisively challenges the narrative that telehealth expansion contributes to drug diversion. Instead, it reinforces the growing body of evidence showing that telehealth improves access to critical treatments, reduces overdoses, and should remain a cornerstone of substance use disorder care. As policymakers and the DEA weigh the future of telehealth prescribing regulations, these findings should serve as a foundation for informed, evidence-based decision-making.