When the Drug Enforcement Administration (DEA) released its proposed rule that would remove some of the Covid-19 telehealth flexibilities for the prescribing of controlled substances, it caused an uproar from telehealth companies and advocates. But the DEA has since pivoted on that stance, holding listening sessions related to those rules and extending the flexibilities through December 31, 2024.
The fact that the DEA is considering less restrictive guidelines on the virtual prescribing of controlled substances gives Stephanie Strong, founder and CEO of Boulder Care, hope when it comes to opioid use disorder treatment. The Portland, Oregon-based company offers virtual addiction care, including the prescribing of buprenorphine, which treats opioid use disorder.
“We know telemedicine is one of the most effective tools and the most urgently scalable,” Strong said during an interview last week at the Behavioral Health Tech 2023 conference in Phoenix. “If we can get treatment to more people faster, that’s how we can reduce this overdose curve that keeps climbing every year.”
The Covid-19 telehealth flexibilities allowed physicians to virtually prescribe controlled substances without an in-person visit. But in March, the DEA proposed a rule that would require an in-person exam before prescribing drugs like narcotics and stimulants. For less addictive psychiatric medications and drugs that treat substance use disorder, patients would be able to get an initial 30-day supply virtually, but would require an in-person visit afterwards.
But requiring an in-person visit for controlled substances would greatly reduce access to the treatments, according to Strong. For example, 40% of counties in the U.S. don’t have a provider who can prescribe buprenorphine. Being able to prescribe these medications via telemedicine makes it easier for patients to see a provider without having to travel long distances, and there is more privacy versus going somewhere in person.
One possible solution is creating a special registration process, which would allow providers to register with the DEA in order to prescribe controlled substances via telemedicine, Strong said. This would help the DEA prevent bad actors while still making it easier for patients to access care. The DEA said back in 2009 that it would implement this process, but has yet to do so.
“We certainly see some advantages [to the special registration process], particularly compared to an arbitrary in-person visit. One being the ability to have a national provider practice,” Strong said.
While Strong is partially in favor of the special registration process, there are some downsides as well. She is concerned that the process would “once again stigmatize this type of medicine, make it look different than other typical prescribing that you would do as a provider.” It would also add administrative barriers for providers, Strong said.
She noted that there are other ways to monitor telehealth providers and keep out bad actors even without the special registration process. For example, each state has a prescription drug monitoring program database. Strong said Boulder Care checks this database each time it fills a prescription to make sure the patient isn’t getting prescriptions from another provider. She suggested modernizing this database by making it national instead of state-by-state, as each state has different protocols of what needs to be reported in the database.
When asked if she feels confident that the DEA will eventually make the telehealth flexibilities permanent or implement the special registration process, Strong said “that’s certainly what they’ve signaled.
“There’s been a lot of openness to discuss the benefits and merits of telehealth,” she said. “We were able to speak at the listening sessions held in D.C. with the administrator and hear her very thoughtful questions about guardrails for medications prescribed over telehealth. … We’re hopeful it’ll go in the right direction.”
Photo: sorbetto, Getty Images
