There’s good news for telemedicine healthcare providers. The Drug Enforcement Agency (DEA) and Health and Human Services (HHS) agencies have extended telemedicine flexibilities through December 31, 2024. The extension will allow healthcare providers to continue prescribing controlled substances based on telehealth patient visits. The DEA’s reasoning for issuing an extension is due to concerns over the continuity of patient care and the careless expedition of online telehealth companies engaging in questionable practices.
In 2020, the DEA temporarily relaxed some of its telemedicine regulations in response to the COVID-19 pandemic. This allowed for greater flexibility in prescribing controlled substances via telemedicine. These temporary changes included the following:
- In-Person Examination Waiver: During the public health emergency, the DEA allowed for telemedicine evaluations without a prior in-person examination. The waiver is typically required in most cases.
- Partial Waiver of Ryan Haight Act Requirements: The Ryan Haight Act had stringent requirements for prescribing controlled substances via telemedicine. The DEA provided a partial waiver of these requirements during the public health emergency.
- DEA Registration Requirements: Telemedicine providers were temporarily allowed to treat patients in any U.S. state, regardless of the provider’s DEA registration location.
The Telemedicine Revolution
Although telemedicine had been in practice for decades, it debuted into the healthcare landscape during the COVID-19 pandemic. With stay-at-home orders across the United States, healthcare providers use telemedicine to stay committed to their patients and continue offering quality healthcare services. Telemedicine delivers medical care to patients at a distance, providing enhanced quality care, decreased patient readmissions, and decreased healthcare costs for patients and healthcare facilities.
During the COVID-19 pandemic, access to telemedicine decreased the number of in-patient visits and consultations. Telemedicine was instrumental in reducing the spread of disease through more efficient surveillance of patients, early identification of infectious disease processes, allowing for immediate care, and continuing care for patients with chronic illness.
Telemedicine perks include:
– Face-to-face direct videoconferencing with patients
– Easier connections made with other healthcare providers with flexible accessibility to review medical data and images with feedback
– Tools that provide for better remote monitoring of patients
– More accessibility to healthcare providers worldwide to provide patient consultations
Prescribing Controlled Substances Using Telehealth
The telemedicine flexibilities that were in place during COVID-19 state that:
– A healthcare provider can prescribe a controlled substance to a patient using telemedicine even if the patient is not in a clinic or hospital registered with the DEA.
– Buprenorphine can be prescribed by qualifying healthcare providers to existing and new opioid use disorder patients based on telephone evaluations.
According to a study in JAMA Psychiatry 2023, patients who were treated for opioid-use disorder through a telehealth provider and seen between September 2019 and February 2021 were found to have a 33% lower rate of fatal overdose than patients who received no medication.
Patients who had an opioid use disorder were able to start buprenorphine treatment with decreased delays compared to in-person visits and evaluations. Studies have found that the standard issue patients with abuse disorders face is access to transportation and childcare.
Overall, drug overdose deaths were found to have increased during the COVID-19 pandemic, spanning over one hundred thousand deaths in 2021. Approximately 755 of those deaths were related to opiate abuse. The Centers for Disease (CDC) reported that the increased deaths were a result of social distancing, disruption of healthcare, and stay-at-home orders.
The ‘Darkside’ of Telemedicine
The disadvantages of telemedicine include:
- Restrictions in performing physical exams.
- Technical difficulties.
- Breaches in patient confidentiality and security.
- Various regulatory barriers.
Many researchers also argued that online interactions are impersonal and potentially dangerous because an online provider may need an accurate health history and physical exam from the patient.
Along with the COVID-19 telehealth revolution came an increase in equity funding for various telehealth startups, which reached over 18 billion dollars. Unfortunately, practices at these new telehealth ‘startups’ have been known to engage in evil activities such as liberal prescribing at Cerebral and Done Health, which created possible violations of the Controlled Substance Act, which alerted the U.S. Department of Justice to launch an investigation. They further noted that the private health information of patients was being distributed to advertisers by BetterHelp, which prompted an intervention from the Federal Trade Commission.
The DEA’s Proposed Rules
The DEA is proposing a rule that all patients prescribed non-narcotic schedule III through V drugs must be seen by a prescribing healthcare provider and have undergone an in-person evaluation by the telemedicine provider. The rule also states that the telemedicine provider can prescribe up to a 30-day supply of non-narcotic schedule III through V medications.
Patients who are receiving buprenorphine for the strict purpose of opioid use disorder must also be seen in person and can receive a 30-day supply of medication.
Controlled substances bring with them increased risks of misuse and dependency, which can have fatal consequences. The DEA’s focus is to limit inappropriate prescribing practices.
In-person healthcare visits and medical examinations decrease the risk of misuse by:
-Assessing risks of misuse
-Ruling out medical causes of symptoms
-Provides accompanying data to audio and telehealth examinations and visits
Earlier this fall, the DEA held two days of ‘listening sessions’ where over thirty-eight thousand comments regarding the proposed telemedicine rules were received. The American Academy of Medicine’s (AMA) president, Dr. Jesse Ehernfeld urged the DEA to adopt a federal policy regarding the prescribing of controlled substances based on telehealth visits that will continue to support patients’ access to evidenced-based care. The AMA’s focus is to provide access to care with a mix of in-person and telehealth visits to better meet the needs of every patient.
The DEA states that they will continue to monitor all input received and are working to put together a final set of telemedicine regulations by the fall of 2024. This allows ample time for patients and healthcare providers to plan and prepare for the new rules and regulations once they are executed.
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