Last week, the Biden administration proposed new regulations on doctors' ability to prescribe certain medications via telehealth, a policy suggestion that the administration framed as necessary to combat the opioid epidemic and prevent unnecessary prescriptions of controlled drugs. However, the proposed change would also make obtaining necessary—even life-saving—drugs more difficult, especially for those living in rural areas.
During the early stages of the COVID pandemic, the Drug Enforcement Administration (DEA) temporarily lifted restrictions on doctors' ability to write prescriptions for controlled drugs via telehealth. However, the agency is poised to bring telehealth under regulation again, bringing back strict limits on how and when doctors can prescribe certain drugs.
DEA officials announced the proposed regulations on Friday. The rules would render most controlled drugs ineligible for prescription via telemedicine appointment—severely restricting patients' ability to obtain drugs without an in-person examination.
"DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm," DEA Administrator Anne Milgram said in a Friday press release.
However, the proposal contains several carve-outs. Under the policy, Schedule III-V controlled medications can still be prescribed via telemedicine. But patients would be limited to a 30-day supply, after which the patient would be required to have an in-person visit in order to get a refill. The same exception applies to buprenorphine, a drug used to treat opioid substance abuse. Further, under the proposed rule, patients can get indefinite prescriptions for controlled substances via telehealth but only if they are referred to a telehealth physician after receiving an in-person examination by another doctor.
The proposed rule would affect all "controlled" prescription drugs, a wide range of drugs including not only opioids like oxycodone and Vicodin but also other drugs like Adderall for ADHD and Ambien for insomnia. The proposed changes will go into effect in mid-May, immediately after the announced end of the COVID-19 national emergency.
Officials justified the regulations by citing concerns over the risk of overprescription of controlled drugs. While administration officials did mention the benefits that telehealth services bring to rural Americans, there is little consideration of how these services are equally important to many who rely on controlled drugs—and the increased risk that desperate patients will turn to significantly more dangerous drugs to alleviate their symptoms.
"As a health policy lawyer w. chronic pain & ADHD, I cannot overstate how unnecessary & cruel this policy is given what visits look like in person v. Telehealth," wrote health policy lawyer Madeline T. Morcelle on Twitter. "Or how deadly this could be for those who struggle to get to [appointments] due to disability or transport/geographic barriers."
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