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As the expiration of the Covid-19 public health emergency declaration approaches, the US Drug Enforcement Administration has expanded flexibilities regarding the prescription of controlled medications via telehealth.
Before the pandemic, doctors were subject to the conditions of the Ryan Haight Lawthat required at least one in-person medical exam before prescribing a controlled drug, Dr. Shabana Khan, chair of the American Psychiatric Association’s Committee on Telepsychiatry, told CNN. previous story about flexibilities.
Controlled medications include stimulant medications for attention deficit hyperactivity disorder, benzodiazepines for anxiety, or medications for opioid use disorder, sleep, or pain. The DEA website has a general list of controlled substancesand a the exhaustive list can be found here.
An exception to this law has been a public health emergency declared by the Secretary of the US Department of Health and Human Services, or HHS, that has been in effect for the past three years due to the Covid-19 pandemic.
“It was immensely helpful,” Khan said, “and allowed many Americans to get medical care without having to come in person, so we were able to treat patients completely remotely.”
With the public health emergency scheduled to end on May 11, the DEA on March 1 issued two proposals that would put some flexibility into the telehealth framework going forward, Khan said: The proposals would allow telehealth professionals to prescribe a 30-day supply of buprenorphine, an opioid use disorder medication, or non-controlled Schedule III-V narcotic medications without first conducting an in-person examination. A patient would have to have an in-person exam before the second prescription of any kind of drug, under those proposals.
The agency received more than 38,000 messages during the official public comment period, which was open through March.
Before today’s DEA extension, without a guarantee that those proposals would pass, patients who have been receiving certain controlled drugs would have had to prepare for not experiencing a disruption in care. But now, while the DEA and HHS consider public comments and revisions to the proposed rules, the DEA and the Substance Abuse and Mental Health Services Administration have decided that these telehealth flexibilities will remain in effect for six more months, until on November 11.
“We take these comments seriously and are carefully considering them,” DEA Administrator Anne Milgram said in a news release. “We recognize the importance of telemedicine in providing Americans with access to necessary medications, and we have decided to extend the current flexibilities by six months as we work to find a way to provide Americans with that access with the appropriate safeguards.”
Ultimately, there will be a final, permanent set of regulations, according to the DEA.
Additionally, “if a patient and physician have established a telemedicine relationship on or before November 11, 2023, the same telemedicine flexibilities that governed the relationship up to that time are permitted through November 11, 2024.” according to the DEA (PDF).
This means that any doctor-patient telemedicine relationship that begins after November 11 will be subject to the pre-pandemic rules, unless there is a new final rule that says otherwise by then, according to a DEA spokesperson.
The DEA’s decision has been praised by the Chairman of the American Medical Association Pain and Substance Use Task Force, Dr. Bobby Mukkamala.
“These medications, including those used to treat opioid use disorder, are a vital form of care for millions of Americans who depend on safe and effective telemedicine appointments,” Mukkamala said. said in a statement. “Patients receiving treatment with these medications often have challenges securing and traveling to in-person appointments. We are grateful that the DEA is addressing this issue with the seriousness it deserves, and we look forward to reviewing the details of the policy when they become available.”
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