February 26, 2023 – While the Drug Enforcement Agency plans to take care of lots of the pandemic-era flexibilities for prescribing controlled substances via telemedicine, it plans to make changes to prescribing criteria for ADHD drugs and highly addictive medications akin to opioids, the agency announced Friday.
If approved, the changes will come into effect upon the top of the general public health emergency on May 11.
“The DEA is committed to ensuring that all Americans have access to the medicines they need,” said DEA Director Anne Milgram in a opinion“Permanently expanding telemedicine flexibility would further improve access to care for patients across the country while ensuring patient safety. The DEA is committed to expanding telemedicine with guardrails that prevent online overprescribing of controlled drugs that can cause harm.”
The proposed rules are designed to permit medical providers to make sure what's referred to as a “continuity of care,” meaning patients can proceed to receive most treatments while still having enough time to schedule in-person appointments.
If someone has seen their doctor in person, they will later be prescribed any controlled substance through a telemedicine visit. Additionally, if someone has seen a physician in person and that doctor sends a referral to a different doctor, akin to a specialist, the specialist can prescribe a controlled substance through telemedicine.
The proposed restrictionswhich apply to substances in Lists II to V are as follows:
- For Schedule II substances – akin to opioids, Adderall and Vicodin – an in-person visit is required.
- Substances on Schedules III through V could also be prescribed for 30 days after an initial telemedicine visit, but a brand new prescription would require an in-person visit thereafter.
- Buprenorphine for substance abuse treatment could also be prescribed for 30 days after an initial telemedicine visit, but an in-person visit is required thereafter for a re-prescription.
Drugs in Schedules III to V include anabolic steroids, Ambien, Tramadol, Valium, Xanax, Lomotil and Lyrica.
The proposal doesn't affect telemedicine prescription procurement for non-controlled substances akin to contraceptives, blood pressure or cholesterol medications, antibiotics, skin creams or insulin.
In a press release, the DEA suggested that folks take their medications to this list to see whether it is a controlled substance or not.
The flexibilities granted through the pandemic in prescribing controlled substances were seen as improving access to treatment, especially for people in rural areas. The flexibilities were also seen as an answer to the shortage of qualified prescribers, akin to mental health clinicians, who often schedule appointments weeks prematurely.
But critics say the loose system has led to people being pharmaceuticals they don't need, and rising addiction rates have also fuelled calls for a return to in-person appointments.
“There are really good arguments on both sides of this tension. You don't want barriers that make it harder for people to get the prescriptions they need. But every time you remove those barriers, it's also an opportunity for profiteers to take advantage of the lax rules and sell the drugs to people who may not need them,” said Dr. David Herzberg, an associate professor on the University of Buffalo and an authority on the opioid epidemic and the history of prescribed drugs. The Associated Press.
The DEA is currently collecting public comments on the proposed changes for 30 days.