DEA looks to curb telehealth prescriptions, which advocates say will complicate rural care and addiction treatment

Photo by Ted S. Warren, The Associated Press

The opioid epidemic has become a persistent, brutal feature of American life. "Its despair and suffering echo through cities large and small, from pitched tents . . . to the hamlets and hollows reeling from the opioid epidemic across Appalachia . . . a nation seemingly inured to the startling toll of addiction," wrote Kevin Deutsch of The Rio Grande Sun in Española, New Mexico, long plagued by drugs.

The stories of suffering, death and a medical communities stretched to their limits explain recent push-back against a new Drug Enforcement Administration "plan to resume tighter limits on the prescribing of controlled substances through telehealth," report Stephanie Armour and Liz Essley Whyte of The Wall Street Journal. "Under the proposed rules, other drugs, including Adderall, Ritalin and OxyContin, would require patients to meet in person with prescribers first or be referred by a doctor they met in person. . . . Patient-advocacy groups say the requirements would create barriers to care. . . . The in-person requirement will make it harder for certain patient populations who live in rural areas where there are few doctors or in areas where there are long waits to see a provider, according to organizations opposed to the proposal."

Dr. Bobby Mukkamala, chair of the American Medical Association's Substance Use and Pain Care Task Force, told the Journal, "The DEA proposal requiring an in-person visit within 30 days to get a prescription refill is far too short and unrealistic. For patients being treated for opioid-use disorder, this proposal could result in more overdose deaths. For those who rely on controlled substances, it could result in avoidable emergency visits and hospitalizations." The Journal reports, "Dr. Brian Hurley, new president of the American Society of Addiction Medicine, said adding the requirement risks undermining public safety because the country is in the throes of an overdose crisis."

Why now? "The proposal comes as the Justice Department has been increasing its focus on telehealth companies that prescribe controlled substances [citing] possible violations of the Controlled Substances Act. . . . The Department of Health and Human Services  issued a special alert warning about telehealth fraud and its potential to harm patients . . . . Still, a number of medical groups say the in-person mandate isn't the solution to possible fraud. They say the DEA has rushed through the proposal, which got about 35,000 comments during a 30-day public comment period."

"A Biden official said the in-person requirement is meant to make sure that patients struggling with addiction are also screened for other health problems, such as heart conditions or diabetes," the Journal reports. "Telehealth with medication-assisted treatment for opioid-use disorder was linked with greater patient satisfaction, an overall reduction in healthcare costs, and an increase in the use of buprenorphine, according to a June 2022 study in the journal Telemedicine and e-Health.