Healthcare groups urge DEA to allow physicians to prescribe controlled substances through telehealth

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A group of 72 healthcare organizations, including the American Telemedicine Association and the American Psychiatric Association, has penned a letter to the Drug Enforcement Administration and Department of Health and Human Services asking the agencies to permanently waive the requirement that patients receive an in-person evaluation prior to being prescribed controlled substances via telehealth.

The DEA is currently developing the special registration process for the use of telehealth to prescribe controlled substances under the Ryan Haight Act.

During the COVID-19 public health emergency, the DEA used its authority to waive this requirement, enabling clinicians to prescribe controlled substances remotely via virtual care. This, the groups said, helped patients access clinically appropriate medications, including for mental health and substance use disorder treatment. 

In the letter, the organizations express concern that, when the public health emergency waiver ends, many patients, especially new patients, will be left without access to care.

WHAT'S THE IMPACT

The letter calls on the DEA and HHS to work with Congress to remove the prior in-person requirement permanently post-pandemic, and urges the DEA to eliminate the prior in-person requirement and remove any restrictions on the location of the patient in the Special Registration process.

Highlighted in the letter is a study from the Journal of Substance Abuse Treatment, which focused on two harm reduction primary care programs providing buprenorphine treatment for opioid use disorder via telehealth. The study found the removal of the in-person requirement greatly increased access to care and addressed health inequities.

"This is especially important as mental health and substance use disorders are impacting a growing number of the people across the country," according to the letter.

Exacerbating the issue, the groups claim, is a geographically uneven distribution of behavioral health providers across the United States., along with the ongoing drug overdose crisis and a burgeoning mental health crisis precipitated by the pandemic.

Under the groups' ideal scenario, all appropriate restrictions on the clinician prescribing the controlled substance would remain; the prescribing clinician and the entity dispensing it would still need to have controlled substances authority. The big difference is that the patient would not need to be physically located in a facility with controlled substances authority when the medication is prescribed.

"That requirement is extremely limiting as a facility that has controlled substance authority is likely to have a clinician on site that can prescribe a controlled substance and thus wouldn't need to use telemedicine, whereas a facility that does not have controlled substances authority would," the letter read.

THE LARGER TREND

On the whole, consumers remain highly satisfied with telehealth. In 2020, 53% of respondents to Rock Health's annual survey said they were more satisfied with live video virtual care than in-person interactions. 

This satisfaction decreased somewhat in 2021, however, with just 43% of respondents reporting the same.

The hypothesis posited by Rock Health is that as the pandemic evolved, consumers began to view telehealth as an alternative to in-person care rather than a necessary replacement. Some of the satisfaction patients felt toward the beginning of the pandemic may have been rooted in gratitude at having any care options at all.

Either way, physicians' attitudes toward virtual care mirror these trend lines. In 2020, 64% of physicians viewed telehealth favorably. In 2021, that number dipped slightly to 58%.

Another possible explanation for the decline among patients is changing usage. In 2020, 33% of telehealth users primarily employed the technology for medical emergencies. A year later, 32% of users harnessed telehealth for minor illnesses, 20% for medical emergencies and 18% for chronic conditions. This perhaps is a better reflection of the technology's current strengths as a care model well-suited for low-acuity issues.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com