Loren Bonner
In late 2023, DEA announced that it will continue to allow health care providers to use telemedicine to prescribe certain controlled substances through the end of 2024.
DEA said the temporary authorization is designed “to ensure a smooth transition for patients and practitioners that have come to rely on the availability of telemedicine for controlled medication prescriptions, as well as allowing adequate time for providers to come into compliance with any new standards or safeguards.”
With providers able to continue prescribing controlled substances based on telehealth patient visits, Emily Leppien, PharmD, from Binghamton University School of Pharmacy and Pharmaceutical Sciences in New York, said this will significantly decrease access barriers, especially in more rural patient populations. Binghamton’s hospital-affiliated outpatient pain clinic offers telehealth services for the treatment of chronic pain and SUD. As a pharmacist, Leppien holds telehealth appointments for patients who are referred to her for medication adjustment or management. Patients live anywhere from 5 minutes to 2 hours away from the facility.
“Many patients may experience challenges in securing time or transportation to in-person appointments,” said Leppien. Not only do telehealth services allow for all patients to receive care regardless of location, but patients can also follow up with providers more quickly or frequently.
Controlled substances covered by the rule, which DEA released during the COVID-19 public health emergency, include not only medications for OUD, but also stimulant medications for ADHD and medications for anxiety.
Buprenorphine
In May 2023, just before the expiration of the public health emergency, DEA said it would temporarily extend telehealth flexibilities through November 11, 2023.
In September 2023, DEA hosted a listening session to hear from health care practitioners, experts, advocates, and patients who called on the agency to extend the more lenient rules and create a special registration pathway for remote prescribing.
Pharmacy groups, including the National Association of Boards of Pharmacy (NABP), said it’s important for DEA to balance the need for access to care via telehealth with the risk of inappropriate access and diversion of particular medications.
“In regard to buprenorphine for treatment of opioid use disorder, NABP believes significant barriers to buprenorphine access persist and there are minimal risks of buprenorphine diversion,” said Lemrey “Al” Carter, PharmD, NABP’s executive director.
He said DEA should allow access to buprenorphine via telehealth.
A study published October 18, 2023, in JAMA Network Open found that when health care providers initiated buprenorphine for OUD via telehealth, it enhanced patients’ likelihood of staying in treatment longer compared with starting treatment in a non-telehealth setting. The study was based on Medicaid data from 2019 to 2020 in Kentucky and Ohio. The researchers found that in Kentucky, 48% of those who started buprenorphine treatment through telehealth remained in treatment for 90 continuous days compared with 44% of those who started treatment in nontelehealth settings. In Ohio, 32% of those who used telehealth to start buprenorphine remained in treatment for 90 continuous days compared with 28% of those who started treatment in nontelehealth settings.
Other controlled substances
Carter said NABP’s goal for other controlled substances besides buprenorphine is for DEA to set out clear requirements for pharmacists in its updated rules for telehealth prescribing.
“Pharmacists have a corresponding responsibility to ensure that prescriptions that they fill are valid, and receiving a prescription from a prescriber in a geographic area far from the pharmacy and with whom the pharmacist does not have a relationship has historically been a red flag,” said Carter. “As telehealth models evolve and patients’ access to care is expanded through telehealth, pharmacists need clarity in the rules of the road such that they can have confidence in the validity of prescriptions they receive that resulted from a telehealth visit.”
DEA received over 38,000 public comments, including comments from NABP, to their proposed rules back in March 2023, the majority of which were concerned about restricted access to care. DEA said it hopes to draft new regulations by fall of 2024. ■