DEA extends remote prescribing of controlled substances 

Photo: Luis Alvarez/Getty Images

The Drug Enforcement Administration has extended flexibilities for remote prescribing of controlled substances through the end of 2024.

Final telemedicine regulations are expected to be issued by the fall of 2024, the DEA said.

This is the second extension granted by the DEA. The first was to expire on November 11, but after holding two days of listening sessions and receiving 38,000 comments, a second extension was issued Friday to give the DEA time to consider new rules. 

"We continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations by the fall of 2024, giving patients and medical practitioners time to plan for, and adapt to, the new rules once issued," the DEA said in Friday's release. 

WHY THIS MATTERS

The new extension means that a DEA proposed rule requiring an in-person visit for controlled medications will not go forward.

The American Telemedicine Association, telepsychiatry practices and others have supported the extension and the continuation of allowing these prescriptions to be available without the necessity of an in-person visit.

Remote prescribing supporters Georgia Gaveras, cofounder and chief medical officer at Talkiatry, and Geoffrey Boyce, founder and CEO of Array Behavior Care, attended the September listening sessions.

The sessions gave a voice to people who are treating the patient, said Gaveras, who is board-certified in child and adolescent psychiatry, adult psychiatry and addiction medicine.

"At the core, we want the same things, we don't want diversion or drug abuse," said Gaveras, who believes guardrails can be in place without the doctor and patient being in the same room.

If patients needed to follow the DEA proposed rule mandating in-person visits, many would abruptly lose care, she said, due to wait times and staffing shortages. 

Gaveras and Boyce said they understand the DEA needs a way to monitor prescribing to make sure it's not being abused, especially, said Boyce, by rogue internet pharmacies. There have been incidents when medications have been sent through the mail without an interaction with a doctor.

Boyce and Gaveras jointly submitted to the DEA a request for a special registration process that would allow providers to prescribe medically necessary substances by telehealth. The process would both combat diversion and provide a detailed framework for safe and legitimate virtual prescribing, proponents have said.

The ATA has also praised the DEA consideration of a special registration process and on Friday applauded the remote prescribing extension.

"We are thrilled that the DEA is taking such a thoughtful and thorough approach to creating the right rules around the prescription of controlled substances," said Kyle Zebley, ATA senior vice president, public policy and executive director, ATA Action. "This is a critical issue for millions of individuals and their families, as well as clinicians wanting to provide care to their patients, wherever and whenever they need it." 

Telehealth addresses the mental health crisis in this country, especially in rural areas and for vulnerable populations, the ATA said.  

THE LARGER TREND
 
Before the COVID-19 public health emergency, remote prescribing was constrained by the Ryan Haight Act, which required the practitioner to conduct at least one in-person medical evaluation of the patient. Ryan Haight was a teenager who died in 2001. His parents had found a bottle of the painkiller Vicodin in his room with a label from an out-of-state pharmacy, according to The Washington Post.

Congress passed the Ryan Haight Act in 2008 in response to internet pharmacies selling controlled substances on the internet. 

During the pandemic, waivers allowed for remote prescriptions. The PHE ended on May 11.

In March, the DEA issued a proposed rule that said after a patient and a practitioner had an in-person medical evaluation, that practitioner could use telehealth to prescribe a prescription for a controlled medication.

A practitioner could virtually prescribe a 30-day supply of a controlled medicine, but would then be required to examine the patient in person. 

Telemedicine prescribing would be allowed if there was a qualified referral in place. But this was only after the individual had been seen by a DEA-registered clinician.

The proposed rule was held as the DEA and HHS announced the extension of COVID-19 telemedicine flexibilities until Nov. 11.

The new extension through Dec. 31, 2024, means numerous telehealth flexibilities allowed under the pandemic will need to be decided on a more permanent basis.

"What this means is that next year is shaping up to be the Super Bowl for telehealth, with many of the telehealth flexibilities enacted during the public health emergency set to expire at the end of 2024, including the High Deductible Health Plan and Health Savings Account telehealth tax provision, geographic and originating sites flexibilities, forestalling implementation of Medicare's telemental health in-person requirements, Medicare face-to-face telehealth requirements for hospice care and the Acute Hospital Care at Home Program," the ATA said.

"It is time to quadruple down on our efforts leading into 2024. This is a historic opportunity to make crucial changes to our healthcare system that will appropriately expand access to urgently needed care to some of our most challenged and underserved patient populations. This is not rhetoric, it's a real opportunity that we must not squander." 

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org