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During the COVID-19 pandemic, the opioid epidemic has quietly raged on, requiring states to fight a costly, two-front war. While states have rallied to ensure that opioid use disorder (OUD) treatment remains accessible, organizational and workforce challenges persist and the resources and revenue needed to address them are rapidly changing.

Gaps in treatment infrastructure and behavioral health workforce shortages have historically challenged states’ OUD treatment delivery. In the midst of the pandemic, states are optimizing current flexibility and supports for their behavioral health workforces to help maintain treatment access during the COVID-19 pandemic, while also monitoring how or whether these new strategies will be maintained in the future.

Here are some approaches states are taking to increase access to treatment and address workforce shortages by expanding job descriptions, offering flexible training, and changing licensing requirements:

Modifying licensure requirements. Licensing requirements for providers vary significantly by state, creating barriers for out-of-state practitioners to providing services across state lines. Expanding out-of-state license recognition and preventing licensure lapses can help ensure and expand access to treatment, promote adoption of telehealth services, and address provider shortages.

• New Hampshire, New York, and Pennsylvania have all expanded the ability of out-of-state providers to deliver services within their states through executive orders. New Hampshire allows out-of-state providers to deliver medically necessary services both in person and via telehealth. Similarly, Pennsylvania has issued temporary licenses for out-of-state medical providers and has expedited issuance of temporary licensing. New York has allowed providers licensed in other states and Canada to practice in the state without penalty due to lack of licensure.
• States may also consider delaying the expiration of provider licenses during the pandemic to remove any potential barriers providers may have to delivering services. Following an executive order that extended license expiration dates across provider types, Maryland’s Behavioral Health Administration (BHA) released guidance on licensure extension and new licensure processing specific to behavioral health providers. Professional licenses that would have expired during the period of the current emergency will be extended for 30 days after the emergency order is lifted, though the BHA continues to process licensure and re-licensure applications that are mailed or submitted electronically.

Leveraging licensed providers. As states face workforce shortages that are amplified by COVID-19, officials may find opportunities to leverage licensed providers in unique capacities, particularly in the provision of OUD treatments.

• In Massachusetts, under order of the commissioner of public health, pharmacists may now administer medications for opioid use disorder (MOUD) in clinical settings, a policy shift designed to allow nursing staff who ordinarily handle such responsibilities to be reassigned to treat COVID-19 patients.
• The Ohio’s Board of Pharmacy has adopted temporary regulatory guidance to allow authorized prescribers in opioid treatment programs (OTP) to delegate buprenorphine administration to registered nurses (RNs) and licensed practical nurses (LPNs).

Providing buprenorphine waiver trainings. States have been working to encourage and train providers to become “waivered” or licensed to prescribe buprenorphine long before this pandemic began, and several organizations are now taking advantage of increased flexibility in provider schedules to provide training. Anticipating that overdoses may increase during the pandemic, states can encourage provider engagement with these and similar programs to grow their waivered workforce.

• California Bridge, a program supported in part by the California Department of Health Care Services (DHCS), is offering free online buprenorphine trainings that emphasize the immediate needs of vulnerable individuals during COVID-19.
• Get Waivered, a non-profit program promoting and providing emergency department (ED) provider training, is offering a “Get Waivered Remote” training aimed at ED providers and medical students, recognizing that with clinics operating at limited capacity during the COVID-19 pandemic, EDs may become a more necessary point of care for people with OUD. This training is free and fully remote.

Supporting behavioral health workforces. As with other frontline workers, behavioral health staff working in residential care, institutional settings, and in direct contact with patients are experiencing significant stress working during the pandemic. To support staff without creating new programs and resulting budget demands, states may consider developing resources to support the mental health needs of both licensed and unlicensed workforces.

• The Interim COVID-19 Guidance to Providers and Stakeholders for Behavioral Health and Homelessness Services from the Hawaii Department of Health includes specific burnout prevention and self-care strategies for providers to reduce secondary trauma and help monitor workload and stress.
• Through support provided by the Washington State Health Care Authority and the Division of Behavioral Health and Recovery, the Washington Council for Behavioral Health has developed BH Providers Connect, a listserv for behavioral health providers to connect and support one another through the COVID-19 pandemic.
• As part of their COVID-19 response, Michigan has released “Supporting Emotional Health of the Behavioral Health Care Workforce during COVID-19,” a guide that outlines self-care strategies, resources for providers and their families, and stress management techniques. Additionally, in response to the heightened stresses on long-term substance use disorder recovery, Michigan has also developed guidance on supporting peers during this pandemic.

While these steps in response to COVID-19 are designed to address concerns about treatment access during the pandemic – sometimes, explicitly – policymakers are also considering the long-term service and budget implications of these changes. In a time of historically reduced state revenues, leaders will be considering how policy shifts and adjustments made during this pandemic can or should be adapted for the post-pandemic treatment of OUD, with likely fewer resources to do so.