Telehealth, Medicaid, and the Opioid Crisis: Lessons from Recent Research
The recent expansion of telehealth flexibilities was heralded as a landmark achievement in the fight against the opioid crisis. The prevailing assumption was that by removing barriers to accessing buprenorphine—a cornerstone medication for opioid use disorder (MOUD)—we would see significant growth in prescribing and, ultimately, a reduction in overdose deaths. Yet emerging evidence complicates this narrative. Two recent studies, one in Health Affairs and another in the Journal of the American Medical Association (JAMA), suggest that telehealth alone is not the panacea many hoped it would be. Instead, systemic barriers continue to limit the reach of MOUD and highlight the need for more comprehensive policy strategies.
This article examines the findings of these studies, explores policy implications, and offers a path forward—particularly timely as we observe Suicide Prevention Month, when the intersection of opioid use disorder (OUD) and suicide risk demands urgent attention.
Medicaid Expansion vs. Telehealth: What the Data Really Show
A critical examination of the Health Affairs study, “States With Substantial Increases In Buprenorphine Uptake Did So With Increased Medicaid Prescribing, 2018–24” (Crystal et al., 2025), reveals a crucial insight: while federal telehealth flexibilities did not drive substantial nationwide increases in buprenorphine prescribing, Medicaid expansion did.
Between 2018 and 2024, Medicaid-expansion states experienced a 27.3% increase in all-payer buprenorphine prescribing, compared to a 2.1% decline in states that did not expand Medicaid (Crystal et al., 2025). This striking contrast underscores that insurance coverage—specifically Medicaid—is a far stronger predictor of treatment access than telehealth policy changes alone.
Similarly, Kravet et al. (2025), writing in JAMA, found that the rate of increase in individuals receiving buprenorphine slowed following each major federal policy change, including the introduction of telehealth flexibilities and the removal of the X-waiver requirement. While addiction medicine specialists did increase prescribing, primary care physicians—the group most critical to integrating MOUD into routine healthcare—actually reduced prescribing during the same period. This decline raises concern, as primary care has long been considered a gateway for expanding access to treatment in underserved areas.
Together, these studies illustrate that while telehealth can be a powerful tool, it cannot overcome structural inequities without broader systemic reforms.
Why Didn’t Telehealth Have a Greater Impact?
The disappointing results of telehealth expansion for buprenorphine prescribing invite a deeper exploration of underlying barriers:
Persistent Stigma and Lack of Training: Many clinicians remain hesitant to treat patients with OUD, citing stigma or insufficient training. Studies suggest that stigma continues to reduce provider willingness, particularly outside addiction specialty care (Volkow et al., 2022).
Low Reimbursement Rates: Inadequate reimbursement for MOUD services discourages providers, especially in states without Medicaid expansion, from integrating these treatments into their practices.
Administrative Burdens: Despite eliminating the X-waiver, many states maintain prior authorization requirements and documentation processes that deter providers. Integration with electronic health records also remains inconsistent, creating inefficiencies.
The Digital Divide: Telehealth assumes access to reliable internet, technology, and digital literacy. Populations most vulnerable to OUD—including rural residents and individuals living in poverty—often lack these resources, limiting the reach of telehealth-based interventions (Anderson & Perrin, 2023).
A Policy Roadmap for Expanding Access
The evidence suggests a multi-pronged approach is necessary to achieve meaningful progress against the opioid crisis:
Expand Medicaid Nationwide: Medicaid expansion consistently correlates with higher MOUD prescribing rates. Universal adoption could remove cost barriers for millions of people with OUD.
Increase Reimbursement for MOUD: Fair compensation is essential to encourage providers to incorporate OUD treatment into their practice, particularly primary care.
Invest in Workforce Training: Medical schools, residency programs, and continuing education initiatives should prioritize OUD treatment, including training on stigma reduction, harm reduction principles, and evidence-based MOUD prescribing.
Streamline Administrative Processes: Removing unnecessary prior authorization requirements and improving electronic health record integration would reduce clinician burden and accelerate treatment access.
Close the Digital Divide: Federal and state investment in broadband expansion, affordable devices, and digital literacy programs is critical to ensuring telehealth reaches the populations who need it most.
Suicide Prevention Month: Linking OUD and Suicide
The intersection of OUD and suicide deserves heightened attention. Individuals with OUD face a significantly elevated risk of suicide compared to the general population (Recovery Answers, 2023). This overlap underscores why expanding access to buprenorphine and other MOUD is not only a matter of preventing overdose deaths but also of suicide prevention.
When policymakers invest in treatment access, they are also investing in hope and recovery. Ensuring that individuals with OUD receive timely, affordable, and stigma-free care sends a powerful message: their lives matter, and recovery is possible.
Conclusion
The expansion of telehealth flexibilities for buprenorphine prescribing was an important policy milestone, but it has not delivered the transformative outcomes many expected. Research makes it clear: systemic factors—Medicaid expansion, reimbursement structures, workforce readiness, and digital equity—are far more decisive in determining access to MOUD.
A truly effective response to the opioid crisis requires comprehensive, coordinated reforms that support both patients and providers. By addressing these barriers head-on, policymakers can help reduce overdose deaths, prevent suicides, and create a healthcare system that fully embraces addiction treatment as essential, lifesaving care.
References
Anderson, M., & Perrin, A. (2023). Technology use among rural and low-income populations. Pew Research Center.
Crystal, S., Xie, F., Samples, H., Campbell, A., & others. (2025). States with substantial increases in buprenorphine uptake did so with increased Medicaid prescribing, 2018–24. Health Affairs.
Kravet, S. D., & others. (2025). Individuals dispensed buprenorphine in the United States before and after federal policy changes aimed at increasing access. Journal of the American Medical Association.
Recovery Answers. (2023). Addiction treatment may protect against the risk of opioid use disorder on suicidal behavior.
Volkow, N. D., Blanco, C., & Collins, F. S. (2022). The role of stigma in the treatment of substance use disorders. New England Journal of Medicine, 387(22), 2010–2012. https://doi.org/10.1056/NEJMp2210639