RICHMOND — In Virginia, most provisions from the now-expired federal public health emergency granting expanded access to health care services through telehealth remain active under state law. This week, the U.S. Drug Enforcement Administration announced it is considering whether provisions not under the state’s control allowing flexibility for prescribing controlled substances via telehealth should also remain in force nationwide.
Those flexibilities, which are scheduled to end on Nov. 11, allow medical practitioners to prescribe certain controlled substances — like Suboxone, which is used to treat opioid use disorder, and Adderall, used for attention deficit disorder — via telehealth without first requiring an in-person evaluation.
The DEA is now considering whether it should allow such prescribing to continue as long as a practitioner obtains a “special registration.”
Dr. Albert Arias, president of the Psychiatric Society of Virginia and a practicing psychiatrist with over 20 years of experience, said removing the in-person appointment requirement would be especially beneficial for those in rural and underserved areas.
“I think it’s a good thing that our government is exploring these things, and I think it shows a shift in greater interest on their part in treating addictive disorders and mental health psychiatric disorders,” he said.
However, Arias emphasized the federal requirement for an in-person appointment — instituted in 2008 after 18-year-old Ryan Haight died of an overdose from drugs he obtained online — was put in place for good reason.
Not only do in-person appointments often result in better evaluations and more accurate diagnoses, he said, but they allow toxicology screening to detect other drugs in a patient’s system to be conducted.
Arias said a lot of doctors are aware “there is the potential for misuse of telehealth and for it to actually do harm if it’s not done right.”
One online mental health startup, Cerebral, is currently under investigation by the U.S. Department of Justice for violations of the Controlled Substances Act over allegations that its staff overprescribed controlled substances like Adderall, according to CBS.
Despite these concerns, others argue patients’ easier access to affected medications over the past three years has been far too beneficial to give up.
One of the more vocal advocates for increased flexibility is U.S. Sen. Mark Warner, D-Virginia, who has emphasized telehealth’s significant impact on connecting patients with necessary care.
“Telehealth was a lifesaver for patients during the peak of the pandemic and has since opened the door to uncomplicated and reliable access to a doctor for patients who need it,” Warner said in an Aug. 4 statement. “This rule will be especially meaningful to patients who rely on medications that treat opioid use disorder, among many others.”
The DEA’s initial proposal in March to limit some of the prescribing flexibilities for certain controlled drugs after they expire was met with over 38,000 comments, the “significant majority” of which the agency said expressed concerns about impacts to patients’ access to care.
Paula Tomko, CEO of Central Virginia Health Services, Inc. — which operates 20 community health centers across central Virginia — wrote in one comment that “access to medications to help treat conditions like [substance use disorder and depression] via telehealth has been a lifeline for health center patients.”
“CVHS strongly urges the DEA to review proposals that may negatively impede a patient’s ability to not only receive, but maintain access to medications crucial to their health regimen,” she continued.
While the DEA has not released specifics of what the registration process for allowed prescribers would entail, Arias said he assumes practitioners who are normally capable of prescribing these controlled substances would be included.
“What we do in the future, it needs to be done right in a way that ensures access to care – safe care,” Arias said.
The DEA will hold listening sessions on its new proposal on Tuesday, Sept. 12 and Wednesday, Sept. 13 at DEA Headquarters in Arlington. Those who wish to attend in-person must register online no later than Aug. 21.
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