By Veronica Jean Walsh
The COVID-19 pandemic (pandemic) urged healthcare providers to rapidly adapt to the changing healthcare landscape, especially while Americans were encouraged to stay home to stop the spread of COVID-19. Accordingly, telehealth medicine, delivering and facilitating health services via telecommunications and digital communication technologies, became a safer and more accessible option to patients seeking healthcare.
Before the pandemic, telehealth medicine was relatively uncommon. Providers were inexperienced with telehealth services and the technologies they required; telehealth was also discouraged under the 2008 Ryan Haight Act, which prevented providers from prescribing controlled substances to patients without an in-person visit. The Ryan Haight Act sought to deter over-prescription of controlled substances to combat the ever-growing opioid epidemic; however, following the pandemic’s inception, the Drug Enforcement Agency (‘DEA’) saw the detrimental effects the pandemic had on individuals requiring controlled substance prescriptions. Thus, the DEA waived the in-person visit requirement associated with the Ryan Haight Act for the public health emergency, allowing individuals requiring controlled substance prescriptions to obtain prescriptions without meeting their provider in-person.
Nearly three years after the in-person waiver, the DEA seeks to create a permanent ruling to address telehealth medicine and controlled substance prescribing. In March 2023, the DEA proposed prohibiting providers from prescribing Schedule II and narcotic controlled substances. Providers are also limited from prescribing through telehealth and no in-person encounter Schedule II through V non-narcotic controlled substances, including buprenorphine, for more than 30 days. During the 30-day period, the patient must obtain an in-person medical examination unless referred by a provider who conducted an in-person medical evaluation.
Following the proposed rule’s release, the DEA received many comments. Advocates of the DEA rule claim that the regulations seek to prevent the growth of the opioid epidemic. Proponents of the DEA proposed rule urge that while COVID-19 concerns have lessened, the flexibilities granted to controlled substance prescribing should be drawn back to prevent the opioid epidemic from spiraling.
Critics of the proposed rule, however, are concerned with placing unnecessary barriers to care for vulnerable populations, since, prescribing buprenorphine, a controlled substance used to treat substance use disorder, would now require in-person evaluation. The barriers placed on buprenorphine, a medication used among vulnerable patients, are arguably counterintuitive to the DEA’s desired goal of fighting the opioid epidemic. This concern is especially prominent, as lack of access to care has exacerbated the effects of the opioid epidemic.
Given the public outcry against the DEA’s proposed rule, the DEA decided to extend the Ryan Haight Act waivers through November 2024 while trying to find an acceptable solution. Earlier this month, the DEA held a listening session to receive additional input on whether to permit telemedicine prescribing of controlled substances without in-person evaluation. The in-person evaluation waiver for controlled substance prescribing remains in place; however, the DEA will be forced to issue a more permanent option as the extension proceeds to run.