Biden Administration To Limit Telehealth Prescriptions

DEA Now Requires In-Patient Doctors’ Visits For ADHD And Pain Medications

Following requests made by the Biden administration in late February, the United States Drug Enforcement Administration (DEA) proposed a new rule on Friday, March 3, requiring in-person doctors’ visits to obtain prescriptions for drugs like OxyContin or Adderall, among others. The ruling would reinstate a previous law lifted during the COVID-19 pandemic and will change how millions of Americans receive their Telehealth prescriptions.

Along with Oxycontin and Adderall, officials from the DEA say they will also tighten regulations on how doctors can prescribe other, less addictive medications to patients they have never met. These medications include drugs like Codeine, Xanax, Ambien, and Buprenorphine, a medication commonly used to treat Opioid addiction. Not surprisingly, the DEA’s proposal has confused not only those who use Telehealth but also providers looking to continue caring for their patients virtually.

Tighter standards surrounding controlled substances come amid a record number of Fentanyl-related deaths in the years following the pandemic. In the 12-month period ending in March of 2022, more than 110,000 Americans died of drug overdoses, with over two-thirds directly attributed to Synthetic Opioids like Fentanyl.

A Sharp Rise In Web-Based Medication Prescribers

In the years following the COVID-19 pandemic, there has been a significant increase in web-based Telehealth prescription drug companies. Unfortunately, while many of these companies have helped expand healthcare access to those who may have found it difficult to see a doctor, like people in rural communities, some have used the rising popularity of Telehealth in harmful ways.

One such company is Cerebral Inc., a Telehealth provider founded in 2019 that promised quick and accessible mental health care online. Where Cerebral differed from other reputable online mental healthcare providers was its ability to prescribe controlled substances used to treat various conditions from ADHD to Insomnia.

Cerebral engaged in aggressive social media marketing campaigns, posting ads that platforms like TikTok and Meta removed for being “misleading.” Experts say the ads “overstated the benefits of ADHD medications” and “tied vague symptoms to the condition.” Nurse practitioners from the company also stated that they “felt pressured” to prescribe ADHD medications “regardless of medical necessity.”

Following a lawsuit filed by the former vice president of product and engineering, Matthew Truebe, claiming the company “put profits before patient safety and overprescribed ADHD medications,” the U.S. Attorney’s Office for the Eastern District of New York issued a grand jury subpoena in May 2022.

Cerebral currently remains under investigation by the Department Of Justice (DOJ) for potential violations of the Controlled Substances Act.

The Downside Of Restricting Telehealth Prescriptions

With every new law, proposal, guideline, or other restriction, negative consequences exist. Telehealth has not only provided millions of Americans with accessible healthcare, but for many, it has replaced their in-person primary care physician altogether. Things like child care, transportation, and other barriers can make in-person doctor visits challenging for patients who may struggle with conditions like anxiety, chronic pain, or even substance use disorders.

One report from the National Institutes of Health (NIH) found that those with Opioid use disorder who received Telehealth services had a lower risk of overdosing. The report also stated that the expanded access to Buprenorphine helped people continue their treatment and that unintentional overdose deaths involving the drug did not rise.

Health and Human Services Secretary Xavier Becerra spoke on the potential flexibility of the new rule regarding Buprenorphine, saying that “improved access to mental health and substance use disorder services through expanded telemedicine flexibilities will save lives.”

The exceptions carved out in the new ruling would include the following:

• A 30-day supply of Schedule III-V non-narcotic controlled medications
• A 30-day supply of Buprenorphine for the treatment of Opioid use disorder

Becerra also acknowledged rural Americans’ difficulty accessing health care, noting, “We still have millions of Americans, particularly those living in rural communities, who face difficulties accessing a doctor or health care provider in person. At HHS, we are committed to working with our federal partners and stakeholders to advance proven technologies and lifesaving care for the benefit of all Americans.”

The DEA is giving the public 30 days to comment on the proposals before drafting the final guidance.

The Future Of Telehealth

Despite the rollback of COVID-19-era policies, Telehealth and online therapy remain vital to our healthcare system. Online therapy provides access to mental health and addiction-related care to millions across the country, many of whom may have otherwise not had access before. While restrictions on the types of medications available to Telehealth providers have been limited, it’s important to note that these restrictions are meant to ensure prescriptions are only given when needed and to those who genuinely need them.

In a press release, DEA Administrator Anne Milgram said that her agency “is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”

While the DEA’s ruling states that a patient must visit a doctor in person to obtain specific prescriptions, they only need to do so once, after which they may continue to refill them via Telehealth providers. Additionally, the law would only take effect after a six-month grace period, which the agency plans to do before May 11. This means patients would have until roughly the end of 2023 to see an in-patient doctor before their prescription is no longer fillable.

Patients can still get common prescriptions like antibiotics, skin creams, birth control, and insulin prescribed through Telehealth visits without needing to see an in-person doctor.

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This proposed ruling would not “do away with” Telehealth. On the contrary, Telehealth has only grown in popularity in recent years. However, a conversation between patients and physicians will need to happen before this ruling takes effect.

“There will need to be a lot of education for patients who need these medications so that they understand what the process is and they don’t fall through the cracks,” said Terry Wilcox, CEO of patient advocacy group Patients Rising.

Online therapy is a great option for those seeking help for a substance use disorder or co-occurring mental health disorder. When incorporated into an aftercare program, online therapy has been shown to improve treatment outcomes and encourage long-term sobriety. Learn about online therapy options available to you.