NURS 753 Week 1 Mental Health Policy Paper on the TREATS Act Example

A Prescription That Should Not Expire: The TREATS Act, Telehealth Buprenorphine and What Permanent Law Would Mean for the Psychiatric Nurse Practitioner

Introduction

On a Saturday morning in a rural county with no addiction treatment program, a 34-year-old warehouse worker in opioid withdrawal called a regional telehealth line. A psychiatric nurse practitioner reviewed the state prescription drug monitoring program, assessed withdrawal by phone and sent a buprenorphine prescription to the pharmacy in town. By Monday the patient had an appointment at the clinic forty miles away. Before 2020, that prescription would have been illegal without an in-person examination. Today it is legal only because of a temporary federal rule that has been extended several times.

This paper examines the Telehealth Response for E-prescribing Addiction Therapy Services Act, the TREATS Act, a federal bill that would make that kind of care permanent. It describes the bill and the problem it addresses, reviews the evidence on telehealth initiation of buprenorphine, analyzes the bill's impact on the role of the psychiatric-mental health nurse practitioner, considers objections and outlines an advocacy plan.

The Bill

The TREATS Act, H.R. 1627, was introduced in the House of Representatives on February 26, 2025, by Representatives Donald Norcross of New Jersey and Brian Fitzpatrick of Pennsylvania (Telehealth Response for E-prescribing Addiction Therapy Services Act, 2025). It would amend the Controlled Substances Act to allow practitioners permanently to prescribe schedule III, IV and V controlled substances for the treatment of a substance use disorder through telehealth without first conducting an in-person evaluation, and it specifies that the telehealth evaluation may be conducted by audio-only or by audio and video. Buprenorphine, a schedule III medication, is the drug the bill most affects. The House bill was referred to the Committees on Energy and Commerce and the Judiciary, has drawn 31 cosponsors and remains in committee; a Senate companion, S. 3048, was introduced on October 23, 2025, and referred to the Committee on Health, Education, Labor, and Pensions.

The Problem It Addresses

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 generally requires an in-person medical evaluation before a controlled substance is prescribed through the internet. When COVID-19 was declared a public health emergency, federal regulators at the Drug Enforcement Administration and HHS relaxed that requirement, and the flexibilities have been extended repeatedly since. The most recent temporary extension, announced December 30, 2025, continues them through December 31, 2026, allowing DEA-registered practitioners to prescribe schedule II through V medications by audio-video telemedicine and schedule III through V narcotic medications for opioid use disorder by audio-only encounters without a prior in-person visit (American Association of Nurse Practitioners, 2025). Each extension has come close to its deadline, leaving clinicians and patients uncertain whether the care they rely on will continue. The TREATS Act would end that uncertainty for substance use disorder treatment by placing the flexibility in statute.

The Evidence

Research on telehealth buprenorphine, most of it from the pandemic period, is encouraging but not uniform. In a Rhode Island cohort of 94 people who started buprenorphine through an audio-only hotline encounter, 97.9% filled their prescription within 30 days, two thirds were in withdrawal at the time of the call, precipitated withdrawal occurred in 4.3%, and more than 70% filled a subsequent buprenorphine prescription within 30 days of finishing the hotline supply (Wunsch et al., 2023). That study shows that phone initiation is feasible and safe for most patients, though it was small, observational and drew largely on people with prior buprenorphine experience.

Low-barrier virtual models appear to increase treatment reach. After the city of Paterson, New Jersey, launched a walk-in and virtual prescriber program in 2023, buprenorphine dispensing rose 14.6% to 17.0% more than in comparison cities, although effects on retention were mixed, with no gain against one comparison group and a small decrease against another (Lindenfeld et al., 2026). Telehealth policy alone is not a guarantee. A national study of state policies adopted early in the pandemic found little change in the number of new buprenorphine treatment episodes in 2020 compared with 2019, and states that adopted telehealth payment parity actually had 7.3% fewer new episodes, while joining the psychologist interstate compact was associated with longer treatment episodes (Stein et al., 2025). Telehealth opens a door; whether patients walk through it and stay depends on everything behind the door.

Impact on the Psychiatric Nurse Practitioner Role

Access and Scope

Psychiatric nurse practitioners are a growing share of buprenorphine prescribers, particularly in rural areas. In interviews with 76 nurse practitioners, physicians, managers and regulators in four states, participants described nurse practitioners' contributions to increasing access, serving rural communities and the particular value of psychiatric nurse practitioners in treating co-occurring disorders, while identifying state scope-of-practice rules as a remaining barrier (Chapman et al., 2024). The TREATS Act would not change state scope rules, but it would remove a federal barrier that falls hardest on nurse practitioners serving areas without addiction programs. A psychiatric nurse practitioner in a full practice state could build a telehealth practice that starts treatment the day a patient calls.

Practice Standards and Safety

Permanent authority would also bring responsibility. The scope and standards of psychiatric-mental health nursing call for assessment, diagnosis and treatment grounded in evidence and in the nurse's accountability for safe practice (American Nurses Association et al., 2014). For telehealth initiation, that means a structured protocol: confirming identity, checking the prescription drug monitoring program, assessing withdrawal with a validated scale, screening for co-occurring sedative or alcohol use, prescribing a short initial supply, arranging naloxone and scheduling follow-up within days. Documentation must show the clinical reasoning behind each audio-only start.

Continuity and Integration

Because the evidence shows that initiation without follow-up leads to mixed retention, the bill's value depends on psychiatric nurse practitioners building continuity: linking telehealth starts to ongoing care, integrating psychotherapy such as motivational interviewing and treating depression, anxiety and trauma that often accompany opioid use disorder. The psychiatric nurse practitioner is well placed to provide both the medication and the mental health care in one relationship.

Equity

The bill's audio-only provision matters most for patients least able to use video: people without broadband or a smartphone data plan, older adults, people experiencing homelessness and many rural residents. For these patients the telephone is not a lesser form of telehealth but the only one available. A psychiatric nurse practitioner who can start treatment by phone can reach a patient calling from a borrowed cell phone or a shelter landline, which video-only rules would exclude. Permanent law would also let health systems and community clinics invest in telehealth addiction services with confidence that the model will still be legal next year, which temporary extensions do not allow.

Concerns and Opposing Views

Opponents of permanent telehealth prescribing raise concerns about diversion and about poorly supervised online prescribing businesses, a concern sharpened by enforcement actions against some telehealth companies during the pandemic. These concerns are legitimate. The bill limits its permanent flexibility to schedule III through V medications for substance use disorders, excluding schedule II stimulants, which narrows the risk. Psychiatric nurse practitioners can support safeguards that do not reintroduce the in-person barrier, such as monitoring program checks, limits on initial supply and documentation standards, as DEA continues work on permanent regulations.

A Biblical Perspective

Jesus said that those who are well have no need of a physician, but those who are sick, and He ate with the people others avoided (English Standard Version Bible, 2001/2016, Mark 2:17). People with opioid use disorder are among the most stigmatized patients in health care, and many live far from treatment. A policy that lets a nurse practitioner meet them by phone on the day they ask for help reflects that ministry of going to the sick. Stewardship also applies: the same law must be used carefully, with safeguards that protect patients and communities.

Advocacy Plan

I will take three steps. First, I will contact my representative's office to ask for cosponsorship of H.R. 1627, sharing a composite patient story and the evidence summarized here. Second, through my state chapter of the American Psychiatric Nurses Association, I will monitor DEA's permanent rulemaking and submit a comment supporting audio-only initiation for opioid use disorder with practical safeguards. Third, in my own practice, I will adopt a written telehealth initiation protocol so that my care shows what safe permanent authority would look like.

Conclusion

The TREATS Act would make permanent a temporary flexibility that has allowed clinicians to start buprenorphine by telehealth, including by phone, without an in-person visit. Evidence suggests telehealth initiation is feasible and can expand access, though retention depends on the care that follows. For psychiatric nurse practitioners, especially in rural areas, the bill would remove a federal barrier, while calling for protocols, documentation and continuity of care that make the expanded authority safe.

References

American Association of Nurse Practitioners. (2025, December 30). DEA announces teleprescribing flexibility extension through 2026. https://www.aanp.org/news-feed/dea-announces-teleprescribing-flexibility-extension-through-2026

American Nurses Association, American Psychiatric Nurses Association, & International Society of Psychiatric-Mental Health Nurses. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Nursesbooks.org.

Chapman, S. A., Fraimow-Wong, L., Phoenix, B. J., Tierney, M., & Spetz, J. (2024). Perspectives on APRN prescribing of medications for opioid use disorder: Key barriers remain. Journal of Substance Use and Addiction Treatment, 157, Article 209215. https://doi.org/10.1016/j.josat.2023.209215

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Lindenfeld, Z., Barnett, M. L., Hua, J., & Crystal, S. (2026). Increased buprenorphine prescribing following implementation of a low-barrier virtual prescriber network. Journal of Substance Use and Addiction Treatment, 191, Article 210114. https://doi.org/10.1016/j.josat.2026.210114

Stein, B. D., Saloner, B. K., Sheng, F., Sorbero, M., Dick, A. W., & Gordon, A. J. (2025). Associations between state policies facilitating telehealth and buprenorphine episode initiation and duration early in the COVID pandemic. Journal of General Internal Medicine, 40(9), 1986-1994. https://doi.org/10.1007/s11606-024-09188-6

Telehealth Response for E-prescribing Addiction Therapy Services Act, H.R. 1627, 119th Cong. (2025). https://www.congress.gov/bill/119th-congress/house-bill/1627

Wunsch, C., Wightman, R., Pratty, C., Jacka, B., Hallowell, B. D., Clark, S., Davis, C. S., & Samuels, E. A. (2023). Thirty-day treatment continuation after audio-only buprenorphine telehealth initiation. Journal of Addiction Medicine, 17(2), 206-209. https://doi.org/10.1097/ADM.0000000000001077