Facing pushback from clinicians and patients, the US Drug Enforcement Administration (DEA) has extended through November temporary pandemic rules for physicians and clinicians dispensing controlled drugs. The rules, which allow prescriptions of controlled medications or buprenorphine without an in-person visit, were set to end when the federal public health emergency ends May 11.
The temporary rules now will remain in effect through November 11, according to a DEA temporary rule released Tuesday. Clinician-patient relationships established before November 11 also will be allowed to continue for an additional year, through November 11, 2024.
The delay reflects the complexities of unwinding the many federal waivers and flexibilities granted to clinicians to make treatment more accessible during the pandemic.
Some telehealth waivers and flexibilities not involving controlled drugs have been extended through 2024. But the DEA in February proposed postpandemic rules that would allow clinicians to remotely prescribe a 30-day supply of controlled drugs but also require an in-person visit for future prescriptions. Drugs covered by the proposed restrictions include Schedule III, IV, or V medications or buprenorphine for opioid use disorder.
The backlash was swift, however, as patients and clinicians flooded the DEA website with more than 38,000 public comments, most protesting the proposed rules.
"We take those comments seriously and are considering them carefully," DEA Administrator Anne Milgram said in a press release. "We recognize the importance of telemedicine in providing Americans with access to needed medications."
The extension allows the DEA time to reconsider its approach. Patients and clinicians praised the eased rules for making it easier to access treatment for substance abuse, pain, and ADHD and said that in-person requirements would be a barrier to care. A study published in JAMA Psychiatry found that telehealth for opioid use disorder was used far more often during the pandemic than before COVID-19, and patients using such appointments were 33% less likely to die of a drug overdose.
"I have been using Telehealth appointments for my drug rehabilitation for over a year now and I am so incredibly grateful for the opportunity to do so," one patient wrote. "Please, I beg of you don't make these regulations the new standard for care. I am extremely terrified that if you do my rehabilitation and recovery will suffer, immensely."
Chester Abbott, MD, a child and adolescent psychiatrist in Pasadena, California, commented that the eased telehealth rules were "a rare silver lining to a serious health crisis," particularly for rural patients. The DEA's proposed restrictions, he wrote, will unintentionally worsen that crisis.
Requiring in-person visits for prescriptions does not prevent fraud, abuse, or drug diversion, wrote Dori Martini, vice president, Government & Regulatory Affairs, Circle Medical group, which is affiliated with the University of California San Francisco. She noted that federal inspector general reports and investigations during the pandemic found that cases of fraud via telehealth in the Medicare program have been rare.
"The DEA's proposal to turn back the clock risks the health and lives of vulnerable patients," wrote Kate Nicholson, executive director and founder of the National Pain Advocacy Center. "Amid colliding public health crises, the DEA should thoughtfully support expanded access, not cut lifelines.
Barbara Feder Ostrov is editorial director, business of medicine, for Medscape/WebMD.
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Cite this: After Backlash, Feds Extend Pandemic Telehealth Rules for Controlled Drugs Until November - Medscape - May 10, 2023.