The American Telemedicine Association and its ATA Action group issued a statement on Monday outlining their opposition to the U.S. Drug Enforcement Administration's proposed permanent changes to rules around the prescribing of controlled medications via telemedicine. 

WHY IT MATTERS

The DEA says it is expanding patient access to critical therapies beyond the scheduled end of the COVID-19 public health emergency – except for the remote prescription of controlled substances.

The top drug agency proposed tighter limits for online prescriptions of some medications, such as Adderall to treat attention deficit hyperactivity disorder (ADHD), opioids, and some non-narcotic drugs such as Ambien, Valium, Xanax and ketamine, in a partial reversal of pandemic telehealth flexibilities, according to the New York Times.

For opioid use disorder drugs such as buprenorphine and certain other medications, prescribing medical practitioners that have never conducted an in-person evaluation of a patient will be allowed to prescribe a one-month supply through telemedicine, with an in-person consultation required for refills, when the PHE ends on May 11, according to a DEA announcement. 

"The proposed rules from the DEA are significantly more restrictive than is warranted," responded Kyle Zebley, the ATA’s senior vice president of public policy and executive director of ATA Action, in a statement.

There is a potential public health crisis for a wide variety of medical circumstances, including mental health and substance use disorders, he said.

"The continuity of care for countless Americans will be severed, potentially leaving these patients to fall through the cracks of our healthcare system without access to needed medications," said Zebley. 

The DEA and proponents of tighter restrictions say that the goal is to prevent the misuse and abuse of controlled substances. 

Separately, the New York Times investigated online prescriptions of ketamine to treat depression and found that a lack of follow-up and screening could mean that ketamine was acquired without proper medical supervision.

Meanwhile, the ATA calls the new rules that would require patients who initiated treatment through telehealth during the pandemic to be seen in person once the PHE ends unnecessary. 

"As the ATA, ATA Action, provider groups and patient advocates have long stated, mandatory in-person visits are clinically unnecessary barriers to appropriate care," Zebley said.

The public has 30 days to comment, and the ATA says it will be sending more extended comments.

THE LARGER TREND

While critics of the PHE drug waivers that allowed online prescriptions say that the system was abused, numerous healthcare organizations have asked the DEA to revise telehealth controlled substance rules and make them permanent. 

The use of telehealth to provide buprenorphine helped increase access to care and overcome health inequities, they said. 

Patients who are geographically distant from their clinicians or face other disparities have been a concern with the end of the PHE looming.

The Ryan Haight Act mandated that the DEA establish a rule ensuring that healthcare providers can successfully prescribe controlled substances via telehealth, and The SUPPORT Act mandated the DEA issue rulemaking by October 2019. 

But, it didn't happen.

"In practice, the DEA’s failure to address this issue means that a vast majority of healthcare providers that use telehealth to prescribe controlled substances to and otherwise treat their patients have been deterred in getting them the quality care they need," according to the website of Sen. Mark Warner, D-Va.

"These restrictions have been temporarily waived during the COVID-19 public health emergency, and I welcome that, but patients and providers need a more permanent and long-term solution to this long-delayed rulemaking," he wrote in 2021.

ON THE RECORD

"DEA is committed to ensuring that all Americans can access needed medications," said Anne Milgram, DEA administrator, in the agency's announcement about its long-awaited proposed rule made in conjunction with U.S. Health and Human Services.

"The permanent expansion of telemedicine flexibilities would continue greater access to care for patients across the country while ensuring the safety of patients. DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm," she concluded.

"We appreciate some of the positive provisions offered by the proposed rules, including allowing care to be delivered uninterrupted for 180 days after the end of the COVID-19 Public Health Emergency for those prescribing relationships that have been established during the last three years," Zebley noted in the ATA's statement.

"Our hope is that the DEA works with us to avoid unnecessary and inappropriate restrictions on the prescription of essential medications for these vulnerable and underserved populations," he said.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.