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Substance Use Disorder

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Photo by Markus Winkler on Unsplash

A federal judge has halted President Donald Trump’s freeze on federal aid programs, ruling that the courts need more time to consider the potentially far-reaching ramifications of his order.

Minutes before the directive from Trump’s budget office was to take effect Tuesday, U.S. District Judge Loren AliKhan blocked the Trump administration from implementing it for now.

AliKhan’s order will expire February 3 at 5:00 pm. The Trump administration cannot suspend disbursement of any congressionally-appropriated funds until then. The judge described the move as a “brief administrative stay” intended to maintain the status quo while further litigation can play out.

“I think there is the specter of irreparable harm,” said AliKhan, an appointee of President Joe Biden.

The ruling is a win for nonprofit and public health groups who said even a brief implementation of Trump’s freeze could cause devastating outcomes for people who rely on federal funds for services, as well as the workers who provide them. The nonprofits also argued the order from the Office of Management and Budget intrudes on First Amendment rights by seeking to block funding for groups that engage in “DEI programs” or promote “Gender Ideology Extremism,” concepts targeted in Trump’s initial round of executive orders.

Justice Department attorney Daniel Schwei had argued that the groups had failed to show that they needed an immediate halt to the order issued by Trump’s budget office and set to take effect at 5:00 pm Tuesday. He said additional guidance offered by the Trump administration should alleviate concerns about the OMB directive cutting off essential programs.

“They request sweeping relief… not tethered to any identified grant programs,” Schwei said. “It would be appropriate to allow these issues to be addressed on a more orderly timeframe.

RCPA will continue to update members as we work with our national partners to gain greater clarification on this Federal action. If you have further questions, please contact your RCPA Policy Director.

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Each year at the National Council for Mental Wellbeing Conference (NatCon25), RCPA and sponsors host the Pennsylvania Reception. This reception is extremely well-attended and is a highlight of the conference for PA registrants, National Council staff, and other invited guests. We are excited to have the conference held in our Keystone State of Pennsylvania on May 5 – 7, 2025. The PA Reception will be held on Tuesday, May 6, 2025. As we near the event, additional details will be provided.

The success of this event has been from the support of our dedicated sponsors. The reception offers food, drink, entertainment, and special name recognition of the supporting organizations. Please contact Tina Miletic if you are interested in sponsoring the PA Reception or if you have any questions.

RCPA thanks all previous sponsors, and we hope we can count on your continued support!

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The Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs (ODP) are jointly hosting the quarterly Statewide Positive Approaches & Practices meeting. This meeting aims to provide the most recent research and resources for people with mental health and behavioral challenges, intellectual disabilities, autism, and other developmental disabilities to live an everyday life.

Date: February 20, 2025
Time: 10:00 am – 3:00 pm
Location: Online – Zoom Webinar
Register Here

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Separate Notice of Proposed Rulemaking Would Completely Eliminate In-Person Evaluation for Prescribed Medications

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Drug Enforcement Agency (DEA) this month released three new prescribing-related telehealth rules.

The Final Rule On the Expansion of Buprenorphine Treatment Via Telemedicine Encounter authorizes DEA-registered practitioners to prescribe Schedule III-V controlled substances, including buprenorphine, for opioid use disorder, through an audio-only encounter for an initial six-month supply (split among multiple prescriptions over six calendar months). Although the rule has been published in the Federal Register and is set to take effect February 18, 2025, President Trump issued a regulatory freeze pending review that requires executive departments and agencies to consider postponing the rule’s effective date for 60 days to review “any questions of fact, law, and policy that the rules may raise.”

Under this final rule, practitioners must first review the patient’s prescription drug monitoring program data for the state in which the patient is located during the telemedicine encounter. Additional prescriptions can be issued under other forms of telemedicine as authorized under the Controlled Substances Act, or after an in-person medical evaluation is conducted. SAMHSA advises practitioners to check with their state medical boards about what specific telemedicine practices are currently authorized for prescribing controlled medications after this six-month period. RCPA has reached out to the Pennsylvania Department of State to determine whether there are telemedicine pathways in place to enable prescribing beyond the initial six-month period without an in-person examination.

This regulation also requires the pharmacist to verify the identity of the patient prior to filling a prescription. This final rule does not apply to practitioners who have already evaluated their patient in person.

Separate Proposed Rule Would Completely Eliminate In-Person Evaluation for Prescribed Medications

However, a separate proposed rule on Special Registrations for Telemedicine and Limited State Telemedicine Registrations would establish special registrations that will permit a patient to receive prescribed medications through telemedicine visits without ever having an in-person medical evaluation from a medical provider. According to the DEA, the special registration is available to medical providers who treat patients for whom they will prescribe Schedule III-V controlled substances. An Advanced Telemedicine Prescribing Registration is available for Schedule II medications when the medical practitioner is board certified in one of the following specialties: psychiatrists; hospice care physicians; physicians rendering treatment at long term care facilities; and pediatricians for the prescribing of medications identified as the most addictive and prone to diversion to the illegal drug market. This regulation allows specialized medical providers to issue telemedicine prescriptions for Schedule II-V medications.

DEA is seeking public comment by March 18, 2025, on additional medical specialists that should be authorized to issue Schedule II medications. Public comments will also be requested on additional patient protections for the prescribing of Schedule II medications by telemedicine, including whether the special registrant should be physically located in the same state as the patient being prescribed Schedule II medications; whether to limit Schedule II medications by telemedicine to medical practitioners whose practice is limited to less than 50 percent of prescriptions by telemedicine; and the appropriate duration needed for the rules’ provisions to be enacted.

For the first time, online platforms that facilitate connections between patients and medical providers that result in the prescription of medications will be required to register with DEA. This is critical, as DEA has found some unscrupulous medical providers on online platforms have used flexible telemedicine rules to put profit ahead of the well-being of patients.

The special registration rule will also require the establishment of a national PDMP to help the health industry protect against abuse and the diversion of controlled substances into the illegal drug market. A national PDMP will provide pharmacists and medical practitioners with visibility of a patient’s prescribed medication history.

Additionally, a Final Rule on Continuity of Care Via Telemedicine for Veterans Affairs (VA) patients was issued, allowing practitioners acting within the scope of their VA employment to prescribe controlled substances via telemedicine to a VA patient with whom they have not conducted an in-person medical evaluation. VA practitioners are permitted to prescribe controlled substances to VA patients if another VA practitioner has, at any time, previously conducted an in-person medical evaluation of the VA patient, subject to certain conditions.

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The Substance Abuse and Mental Health Services Administration (SAMHSA) has released updated National Behavioral Health Crisis Care Guidance aimed at enhancing the nation’s response to mental health and substance use crises. This effort is part of an ongoing initiative to address record-high rates of suicide and overdose, while also building on the transition to the 988 Suicide & Crisis Lifeline in 2022.

The updated National Behavioral Health Crisis Care Guidance is comprised of three key documents. These are the 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care, Model Definitions for Behavioral Health Emergency, Crisis, and Crisis-Related Services, and a draft Mobile Crisis Team Services Implementation Toolkit, which is open for public comment until March 21, 2025. Together, these resources set forth a framework for reshaping community crisis care systems and ensuring timely access to care.

SAMHSA’s framework is built on three foundational pillars essential to an integrated crisis care system:

  1. Someone to Contact — The 988 Lifeline and other hotlines provide immediate, accessible support for individuals in crisis.
  2. Someone to Respond — Mobile crisis teams are a critical component, delivering rapid, on-site assistance to de-escalate crises and connect people with appropriate care.
  3. A Safe Place for Help — Stabilization services offer facilities where individuals in crisis can access care, resolve crises, and transition to ongoing treatment when necessary.

The new guidance emphasizes scalability and sustainability for these systems, equipping state, tribal, local, and territorial governments with the tools needed to design and improve crisis care services. It also provides practitioners with actionable steps for delivering quality care.

The 988 Suicide & Crisis Lifeline, launched nationwide in 2022, represents a significant shift in behavioral health crisis response. The easy to remember three digit number aims to provide individuals with immediate access to trained crisis counselors, significantly reducing reliance on law enforcement and emergency departments for mental health emergencies. The updated guidance builds on this progress while addressing the urgent need for comprehensive crisis care systems.

The guidance reflects substantial input collected through listening sessions, expert consultations, and public feedback. Crucially, it underscores the importance of a coordinated, flexible, and compassionate approach to behavioral health crises at a time when the nation continues to grapple with increasing demand for services.

With public comments being sought on the draft Mobile Crisis Team Services Implementation Toolkit, SAMHSA aims to refine and finalize tools that advance the capacity of crisis teams to stabilize situations and connect individuals with long-term support. Please forward your comments to RCPA COO and Mental Health Services Director Jim Sharp for inclusion in the RCPA response to SAMHSA. This will addressed in the February 18, 2025, RCPA 988/Crisis Services meeting. You can register for the meeting here.

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Good afternoon OMHSAS Stakeholders,

The Office of Mental Health and Substance Abuse Services (OMHSAS) January 2025 Stakeholder Webinar is currently scheduled for Thursday, January 30, from 3:00 pm to 4:00 pm.

Register here for the webinar. After registering, you will receive a confirmation email containing information about joining the webinar.

For those that want to join via phone:
Call-in Number:   631-992-3221
Access Code:      892-053-544

Please reach out to RCPA COO and Mental Health Services Director Jim Sharp or RCPA Policy Associate Emma Sharp with any questions.

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As the behavioral health system struggles to find in-clinic psychiatric services, the Office of Mental Health and Substance Abuse Services (OMHSAS) has been issuing waivers to providers to address this barrier, while legislative remedies are pursued. There have been some waivers granted in the past year that included conditional language requiring the presence of a psychiatrist in the clinic a minimum of two days per month.

RCPA began discussions with OMHSAS that this condition was difficult to meet and it represents the actual reason for the waiver. OMHSAS has reconsidered this positon and will eliminate that language and requirement for future waivers. In the interim, providers with approved waivers with the above referenced psychiatrist requirements will need to submit a revised waiver request. RCPA thanks OMHSAS for their partnership and consideration on this matter.

If this impacts your organization, please contact RCPA COO & Mental Health Services Director Jim Sharp, who will provide guidance in the resubmission process.

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RCPA will be hosting our 2025 Capitol Day on Wednesday, March 26. We will hold a press conference/rally from 10:00 am – 11:00 am in the Capitol’s Main Rotunda. Members are requested to schedule appointments with their State Senate and House legislators to discuss the state budget, legislation, and regulations that affect the day-today activities of our members. For your convenience and use in legislative meetings, RCPA has developed a brochure highlighting our legislative and regulatory priorities. More information will follow, but if you have questions or suggestions regarding our 2025 Capitol Day, please contact Jack Phillips, Director of Government Affairs.

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