DEA extends telemedicine option for prescribing controlled medications

The federal government will allow doctors to keep using telemedicine to prescribe certain medications for anxiety, pain and opioid addiction, extending for six months emergency flexibilities established during the coronavirus pandemic.

The Drug Enforcement Administration and Substance Abuse and Mental Health Services Administration made the announcement Tuesday, two days before the telemedicine flexibilities were set to expire along with the coronavirus public health emergency.

The ability to prescribe controlled medications will run through Nov. 11. And that deadline will be longer still if doctors have already established a telemedicine relationship with patients. In that circumstance, physicians can keep prescribing the medications virtually through Nov. 11, 2024.

The extension was announced after the DEA received tens of thousands of complaints about its proposal to reinstate stricter rules governing the prescribing of controlled substances that had been loosened at the dawn of the pandemic. The extension will allow officials to review the comments while developing a permanent rule. The controlled medications include drugs such as the attention-deficit/hyperactivity disorder pill Adderall, the painkiller oxycodone and buprenorphine, which is used to treat opioid-use disorder.

“We strongly support policies that promote access to effective and safe treatment for opioid use disorder, including through telemedicine platforms, and ensuring continued access to necessary controlled medications past” the end of the public health emergency, Miriam E. Delphin-Rittmon, the Health and Human Services assistant secretary for mental health and substance-use services, said in a statement.

In March 2020, as the U.S. government sought to limit the spread of the novel coronavirus, it issued an emergency rule allowing doctors to prescribe the controlled medications without face-to-face visits with patients.

As the pandemic eased, the federal government this year had proposed draft rules that would have allowed doctors to remotely prescribe an initial 30-day supply of some controlled medications, such as buprenorphine for opioid addiction or testosterone for hormone replacement therapy. But under the proposal that is now back on the shelf, patients looking to get refills beyond that would have needed to see a physician in person.

Other drugs with a higher risk for abuse or dependency, such as Ritalin for attention-deficit/hyperactivity disorder, would have required an in-person evaluation from the start. The proposals would have given a six-month grace period to patients already receiving prescriptions through telemedicine.

At the time the proposal to restrict telemedicine prescribing surfaced, the DEA had said the tighter standards were aimed at ensuring that patients would be adequately screened by their doctor and at combating potential abuses, such as improper prescribing of controlled medications by telehealth companies. The agency has been facing pressure from law enforcement, and even some health providers, over concerns about the emergence of digital “pill mills,” allowing people to get prescription drugs without a legitimate medical reason.

But the proposals sparked a public backlash, particularly regarding buprenorphine, a medication that is commonly prescribed to treat opioid-use disorder at a time when overdoses are killing more than 100,000 people a year. As part of the rulemaking process, the public is allowed to send in comments to the DEA – and the proposed telemedicine restrictions sparked a record 38,000 comments.

Many came from patients and industry groups who argued the restrictions could alienate vulnerable people, including those who are homeless, live in rural areas or have disabilities that limit mobility.

The DEA late week announced it would be extending the telemedicine flexibilities but did not offer details on how long it would last. The decision was applauded by groups such as the American Society of Addiction Medicine, which said it believes telemedicine prescriptions for buprenorphine are crucial during the overdose crisis.

In a statement last week, Brian Hurley, the society’s president, said the extension is “significant because ensuring continued access to medications for addiction treatment is critical for saving lives.”